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Is the Standard Treatment for Early Syphilis Sufficient to Prevent Cardiovascular and Neurologic Syphilis?

Published:November 06, 2015DOI:https://doi.org/10.1016/j.amjcard.2015.10.048
      We read the study from Roberts et al
      • Roberts W.C.
      • Barbin C.M.
      • Weissenborn M.R.
      • Ko J.M.
      • Henry A.C.
      Syphilis as a cause of thoracic aortic aneurysm.
      about syphilis as a cause of thoracic aortic aneurysm that prompted us to make some considerations. We agree that syphilitic aortitis, far from disappeared, remains a major cause of thoracic aortic aneurism. Besides, coronary artery ostial stenosis, a less common manifestation of syphilitic aortitis, is still described in the study.
      • Tewari S.
      • Moorthy N.
      Cardiovascular syphilis with coronary stenosis and aneurysm.
      Recently, we conducted a survey of the report of the last 5 years on the clinical presentation of neurosyphilis founding 286 affected patients (unpublished data). Regrettably, however, such cases are incompletely reported. In particular, most studies do not inform how early the patients did show cutaneous or mucosal symptoms of early infection, whether they had undergone a standard therapy nor the time elapsed before developing late complications. However, according to the study by Zhou et al and Drago et al
      • Zhou P.
      • Gu X.
      • Lu H.
      • Guan Z.
      • Qian Y.
      Re-evaluation of serological criteria for early syphilis treatment efficacy: progression to neurosyphilis despite therapy.
      • Drago F.
      • Parodi A.
      • Rebora A.E.
      Re-evaluation of serological criteria for early syphilis treatment efficacy: progression to neurosyphilis despite therapy: a reply.
      and evidence that up to 5% of immunocompetent patients treated with benzathine penicillin G (BPG) experience treatment failure
      • Ghanem K.G.
      • Erbelding E.J.
      • Cheng W.W.
      • Rompalo A.M.
      Doxycycline compared with benzathine penicillin for the treatment of early syphilis.
      has wavered our confidence in BPG as the gold standard therapy for early and late latent syphilis. Trying to prevent long-term complications, we adopted in the last 5 years an enhanced therapy for early syphilis that uses doxycycline and ceftriaxone in addition to BPG. In fact, these treponemicidal antibiotics can penetrate all tissues more effectively than BPG
      • Nau R.
      • Sörgel F.
      • Eiffert H.
      Penetration of drugs through the blood-cerebrospinal fluid/blood-brain barrier for treatment of central nervous system infections.
      and might be considered as a completion of the standard BPG therapy.
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      Linked Article

      • Syphilis as a Cause of Thoracic Aortic Aneurysm
        American Journal of CardiologyVol. 116Issue 8
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          In 2009, we described morphologic findings in 22 patients having resection of an ascending aortic aneurysm in the previous 11 years at the Baylor University Medical Center, and histologic examination of the aneurysmal wall disclosed classic findings of syphilitic aortitis. The major purpose of that extensively illustrated report was to describe the characteristic gross features of the aneurysm such that syphilitic aortitis might be better recognized at operation and appropriate antibiotics administered postoperatively.
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