Deputy Health Officer, STD Controller Director, STD Prevention and Control Services Re: Updated Syphilis Screening Recommendations in HIV-infected Patients

While syphilis rates have declined from their peak in 2004, syphilis remains endemic, particularly among HIV-infected gay men and other MSM in San Francisco. In 2007 there were 361 new cases of syphilis of which 65 % were in HIV-infected MSM. Because syphilis in HIV-infected persons can increase HIV viral load and decrease CD4 T cell counts as well as enhance the spread of HIV, routine and regular screening is of medical and public health importance.1,2 The San Francisco Department of Public Health recommends that sexually active HIV-infected gay men and other MSM get a syphilis test with every routine CD4 T cell count or HIV viral load. Persons with newly reactive or a 4-fold increased titer should be treated for syphilis infection with at least one dose of benzathine penicillin G 2.4 million units IM injection. Penicillin allergic patients can be successfully treated with doxycycline 100 mg by mouth twice daily for 14 days.2,3 It is important to remind patients that since syphilis is a reportable disease, new cases may be contacted by the health department to assure timely treatment and to conduct a voluntary interview to elicit and notify recent sex partners or others at risk for infection