BPG plus doxycycline grants higher serologic response in people with HIV, early syphilis
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Key takeaways:
- Single-dose benzathine penicillin G is the preferred treatment for early syphilis.
- Patients treated with benzathine penicillin G plus doxycycline had significantly higher serologic response rates at 12 months.
Adding doxycycline to single-dose benzathine penicillin G — the preferred treatment for early syphilis — achieved higher serologic responses in people with HIV than benzathine penicillin G, researchers found.
“Previously, we observed a high rate of chlamydial coinfection among people with HIV. Due to this finding, physicians at our hospital started adding doxycycline 100 mg twice daily for 7 days in combination with benzathine penicillin G (BPG) to treat this coinfection,” Kai-Hsiang Chen, MD, a researcher in the department of internal medicine at National Taiwan University Hospital, told Healio.
“One day, we had the idea, ‘Does doxycycline affect the serologic response of early syphilis?’ This led us to initiate our study,” Chen said.
Chen and colleagues conducted a retrospective study to compare the treatment responses to single-dose BPG combined with 7-day doxycycline vs. BPG alone in people with HIV who also presented with early syphilis.
For the study, which was conducted between January 2018 through March 2022, 223 people with HIV with 307 episodes of early syphilis received single-dose BPG plus doxycycline, while 347 people with HIV accounting for 391 episodes of early syphilis received only BPG.
Overall, the study showed that people with HIV receiving BPG plus doxycycline had a significantly higher serologic response rate at 12 months of treatment than those receiving just BPG (79.5% vs. 70.3%; P = .006).
The study also showed that factors associated with 12-month serologic response included rapid plasma regain titer (adjusted OR = 1.25; 95% CI, 1.15-1.35) and receipt of BPG plus doxycycline (aOR = 1.71; 95% CI, 1.20-2.46).
“Because this is a retrospective study, the findings may be influenced by various factors,” Chen said. “However, it presents an opportunity to enhance serologic outcomes in early syphilis among people with HIV and guides us toward conducting more advanced studies.”
Chen added that the team plans to assess the impact of short-course doxycycline on the development of antimicrobial resistance in further randomized control trials in the future.
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