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Background. The decision to perform lumbar puncture in patients with asymptomatic human immunodeficiency virus (HIV) infection and syphilis is controversial. The Centers for Disease Control and Prevention recommend certain criteria that warrant lumbar puncture. Here, we assess the performance of these criteria for detecting asymptomatic neurosyphilis (ANS). Methods. Eligible subjects consisted of all patients with concurrent HIV infection and syphilis in a prospective clinical cohort who had no neurologic symptoms at the time of lumbar puncture. We retrospectively applied different stratification criteria to calculate the performance of lumbar puncture in detecting ANS: (1) lumbar puncture in patients with late latent syphilis or syphilis of an unknown duration, regardless of the CD4 cell count or rapid plasma reagin titer; (2) lumbar puncture if the CD4 cell count was ⩽350 cells/mL and/or the rapid plasma reagin titer was ⩾1:32, regardless of the syphilis stage; and (3) lumbar puncture in the context of serologic nonresponse to syphilis therapy. Results. Two hundred two of 231 patients with syphilis did not have neurologic symptoms. Immediate lumbar puncture was performed for 46 patients, and 10 cases (22%) of ANS were detected. With use of the first criterion, 2 (14%) of 10 cases of ANS in patients with early-stage syphilis would have been missed (sensitivity, 80% [95% confidence interval {CI}, 44%-97%]; specificity, 76% [95% CI, 60%-89%]). Criterion 2 would not have missed any cases of ANS (sensitivity, 100% [95% CI, 70%-100%]; specificity, 87% [95% CI, 72%-96%]) but would have required that a lumbar puncture be performed for 88% of patients. Performance of lumbar puncture performed in 13 cases based on serologic nonresponse to syphilis therapy yielded 4 cases (31%) of ANS. Conclusions. In patients with concurrent HIV infection and syphilis, the use of criteria based on rapid plasma reagin titer and CD4 cell count, instead of stage-based criteria, improved the ability to identify ANS. [ABSTRACT FROM AUTHOR]

Background. Syphilis and human immunodeficiency virus (HIV) frequently coexist in patients, but the effects of immunosuppression on the course of syphilis are unknown. Our goal was to determine whether the degree of HIV-mediated immunosuppression and the use of highly active antiretroviral therapy impact syphilis serologic responses. Methods. We assessed all cases of syphilis with positive serologic test results from 1990 through 2006 in a prospective, observational clinical cohort of HIV-infected patients. We defined seroreversion as the loss of reactivity in a patient who previously had a serologic test result positive for syphilis. We defined serologic failure as the lack of a 4-fold decrease in rapid plasma reagin titers 270-365 days after therapy or a 4-fold increase in titers ⩾30 days after therapy. We used Cox proportional hazards models with statistical adjustments for multiple failure instances. Results. One hundred eighty subjects experienced 231 cases of syphilis. The median follow-up time was 5.3 years. A total of 71 episodes of serologic failure were documented. A CD4 cell count of <200 cells/mL at the time of syphilis diagnosis was associated with an increased risk of serologic failure (adjusted hazard ratio, 2.48; 95% confidence interval, 1.26-4.88). The receipt of highly active antiretroviral therapy was associated with a 60% reduction in the rate of serologic failure (adjusted hazard ratio, 0.40; 95% confidence interval, 0.21-0.75), independent of concomitant CD4 cell response. Rapid plasma reagin seroreversion was infrequent (16.1%) and inconsistent, and it was more likely to occur among patients who received macrolides. Conclusion. The use of highly active antiretroviral therapy to reverse immunosuppression and the routine use of macrolides for the prevention of opportunistic infections may reduce syphilis serologic failure rates among HIV-infected patients who have syphilis. [ABSTRACT FROM AUTHOR]

Describes the rate of sexually transmitted diseases among HIV-infected patients in Baltimore, Maryland. Behavioral and clinical characteristics of patients; HIV transmission; High-risk profiles of both men and women.

Presents an editorial calling for better control of sexually transmitted diseases. Belief that health departments, strained by the prevalence of HIV patients and emerging threats like bioterrorism are unable to follow the procedures to follow up on the partners of those with gonorrhea or chlamydial infection; How there has been no progress since 2000 toward the reduction goals for rates of the two infections; Need to develop and implement more efficient and effects models of partner care; Study in this issue of one such program; Details of the study; Belief that while the approach is promising it is not universally applicable; Need to integrate interventions to sexual partners into standard public health policy which will face some obstacles.

The article focuses on the risk factors for chlamydia trachomatis (CT) and neisseria gonorrhoeae (GC) infection in HIV-infected women. Data in the Johns Hopkins HIV Clinical Cohort shows that women who had undergone CT or GC tests were likely to be black and receiving highly active antiretroviral therapy (HAART) and majority of the women were tested for STDs after enrolling in the cohort. Results suggest that young age was an independent risk factor for CT or GC infection among women who were receiving HIV continuity care.