EFFECTIVENESS OF Benzathine Penicillin THERAPY COMPARED TO DOXYCYCLINE BY CLINICAL AND SEROLOGICAL EVALUATION IN SECONDARY SYPHILIS PATIENTS WITH HUMAN IMMUNODEFICIENCY VIRUS (HIV) COINFECTION

Abstract

Syphilis is a sexually transmitted infection that is chronically progressive. Syphilis has a wide spectrum of clinically active and asymptomatic periods. A total of 80,6% of men with syphilis were MSM, and 47% was coinfected with HIV. A 29-year-old man, MSM, diagnosed with HIV, complained of red patches all over his body since two months ago without itching. Benzathine penicillin is treatment choice for syphilis in all stage. In case of penicillin allergy, alternative treatment with doxycycline and azithromycin has similar efficacy with benzathine penicillin through serological evaluation. Dermatological examination showed multiple erythematous macules, well-defined margins, irregular edges, and diffuse alopecia. Venereological status of corpus penis, scrotum, and perianal showed multiple shallow ulcers, erythematous base, well-defined margins, indurated edges, and painless. VDRL titer reactive 1:256 and TPHA titer reactive >1:5120. Patient was diagnosed with secondary syphilis and planned for injection of benzathine penicillin 2.4 million units single dose but the skin test was positive so the treatment replaced with doxycycline 2x100mg for 14 days. Evaluation 1 month later showed an increase in VDRL titer to >1:512 so patient got injection of benzathine penicillin 2.4 million units single dose. Clinical and serological improvement began to be seen with decreasing VDRL titer significantly to 1:32 at the first month evaluation and 1:16 at the third month and no new lesions were found. Benzathine penicillin provides better clinical and serological improvement compared with doxycycline in the treatment of secondary syphilis in HIV patient.