Syphilis — SCE Infectious Diseases MCQ

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ModerateSTIsSyphilisSCE Infectious Diseases

A 35-year-old man with HIV (CD4 310 cells/µL, viral load <50 copies/mL) is diagnosed with secondary syphilis. RPR titre is 1:128. He reports no neurological symptoms. There is no evidence of ocular or otic syphilis. What is the most appropriate treatment?

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Correct answer: E — Benzathine Penicillin G 2.4 MU IM single dose

Secondary syphilis in an HIV-positive patient without neurological, ocular, or otic symptoms is treated the same as in HIV-negative patients: Benzathine Penicillin G 2.4 MU IM single dose. There is no evidence to support enhanced regimens in HIV co-infection for early syphilis if there are no CNS features. CSF examination is not routinely recommended unless there are neurological symptoms or signs, ocular/otic involvement, or treatment failure. The RPR should be monitored at 3, 6, and 12 months for a fourfold decline.

Reference: BASHH 2019 – Guidelines for the management of syphilis; BHIVA 2022 – STI guidelines for people with HIV