High-Dose Oral Amoxicillin Plus Probenecid is Highly Effective for Syphilis in Patients with HIV Infection

Abstract

Background. Intramuscular benzathine penicillin G (BPG) is widely used for the treatment of syphilis. However, BPG is not available in some countries. This study examined the effectiveness and safety of high-dose oral amoxicillin plus probenecid for the treatment of syphilis in patients with human immunodeficiency virus type 1 (HIV-1). Methods. This retrospective observational study included 286 HIV-infected male patients with syphilis (median age, 36 years median CD4 count, 389 cells/μL) who were treated with oral amoxicillin 3 g plus probenecid. Syphilis was diagnosed by both serum rapid plasma reagin (RPR) titers ≥8 and positive Treponema pallidum hemagglutination test. Patients with neurosyphilis diagnosed by cerebrospinal fluid examination were excluded. Successful treatment was defined as a at least 4-fold decrement in RPR titer. Results. The overall treatment efficacy was 95.5% (95% confidence interval [CI], 92.4%-97.7%;273/286 patients), and efficacy for primary, secondary, early latent, late latent, and unknown duration syphilis was 93.8% (95% CI, 68.1%-99.8%;15/16), 97.3% (95% CI, 92.9%-99.2%;142/146), 100% (95% CI, 90.5%-100%;37/37), 85.7% (95% CI, 58.6%-96.4%;18/21), and 92.4% (95% CI, 81.9%-97.3%;61/66), respectively. Treatment duration was mostly 14-16 days (49.7%) or 28-30 days (34.3%), with efficacy of 94.4% (134/142) and 95.9% (94/98), respectively;96.3% of successfully treated patients achieved a ≥4-fold decrement in RPR titer within 12 months. Adverse events were noted in 28 (9.8%) patients, and 25 of these (89.3%) were successfully treated. Only 6% of patients underwent lumbar puncture. Conclusions. The combination of oral amoxicillin 3 g plus probenecid was highly effective and tolerable for the treatment of syphilis in patients with HIV-1 infection.