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Although guidelines indicate that HIV infection should not change the usual treatment regimens for syphilis, many clinicians use extra doses of penicillin “just in case.” Is this practice justified? Researchers retrospectively reviewed the serologic response to syphilis treatment among 1321 individuals who were enrolled in cohorts of HIV-discordant couples in Rwanda and Zambia and followed at least annually between 2002 and 2008.
Overall, 1810 episodes of syphilis were treated, half of them as prevalent disease (defined as an elevated rapid plasma reagin [RPR] titer identified at study enrollment, never before treated) and half as incident disease (an elevated RPR newly identified during study follow-up). Most RPR titers (85%) were 1:8 or le…