A Comparative study of Epidemiology, clinical presentation and serology of syphilis in HIV and Non-HIV patients.

There is strong epidemiological association between HIV infection and syphilis. Both disease are predominantly sexually transmitted and syphilis patients are at increased risk for HIV infection. In HIV infected persons, it has been reported that syphilis shows atypical clinical and serological courses, unreliable response to therapy and premature development of neurosyphilis. Its is well documented that prevalence of STD favours transmission of HIV in the community and control of STD has brought down the transmission of HIV to 42% according to Mwanza study1. This study is designed to compare the epidemiological, clinical presentation, serological variation of syphilis and other associated STDs in presence of HIV infection and in HIV negative patients in our setting. AIMS OF THE STUDY : 1. To study Age and Sex distribution in HIV positive patients. 2. To study Risk factors involved in transmission of syphilis in HIV positives. 3. To study the clinical presentation of syphilis in HIV individuals 4. To assess VDRL titre in HIV (+) and HIV (-) syphilitic patients 5. To study other STD's occuring along with syphilis in HIV positive and Negatives. CONCLUSION This study of male and female syphilitics attending STD clinic clearly points to certain changes in the era of HIV / AIDs. In both study groups, males are commonly affected and 90% of males and females belongs to sexually active age group (15 - 40 years). 40% of both HIV (+) and (-) hailed from rural areas indicating infection increasing in rural population also. 70% of males and 90% of females in both study group are married. But in HIV (+) females, high % are either widowed (22%) or seperated from husband (17%). 70% of females denies H/o sexual act indicating they acquire infection from their partners. Common mode of sexual act in both study group was heterosexual (70%). HIV / AIDs still has high incidence in high risk groups like Truck drivers (36.5%) mason (18%), Hotel Servant (14%) and other lower socio economic groups. So HIV control programme has to focus more on these people since they had the potentiality to spread the infection into General population. Factors like promiscuity (both PMC and EMC) 50%. Past H/o Genital ulcer disease (45%) in males and non usage of condoms are important factors responsible for acquisition of syphilis and HIV. Commonly associated STDs are vulvovaginal - candidiasis (22%), Bacterial vaginosis (16.5%), Herpes genitalis (11%) in HIV (+) females compared to Trichomonisis (25%) in HIV (-) females. Similarly in HIV (+) males, Genital wart (18%), Herpes Genitalis (13.5%) are the common associated STD's. Non venereal conditions like oral candidiasis (18%) Dermatophytosis (12.5%), Scabies (5%), oral hairy leukoplakia (5%) and many constitutional symptoms like fever, weight loss, cough, diarrhoea are commonly associated with HIV infection. In this study Early syphilis was more prevalent in HIV (-) persons (82.5%) than HIV (+) (72.5%). But Late latent syphilis seems to be common in HIV (+) 25% than HIV (-) 12.5%. Some unusual and atypical courses of syphilis were observed in HIV positive patients. One patient (2.5%) with neurosyphilis in HIV negative group has been reported. High non treponemal (VDRL) titres were seen among HIV positive than among HIV negative syphilitics. This was particularly evident in patients with early syphilis. Delayed serological response to standard therapy for syphilis were also observed in HIV positive persons. Though penicillin is an useful drug even in the presence of HIV infection delayed healing of lesions occurs in some. Hence, treatment efficacy should be monitored carefully and regular follow up to rule out neurosyphilis