The relationship of serological parameters in syphilis and the response of the cellular adaptive immunity in HIV-coinfected MSM

Published: July 18, 2010

The relationship of serological parameters in syphilis and the response of the cellular adaptive immunity in HIV-coinfected MSM

H. Jessen1, A. Boubnov1, D. Hechler1, C. Zedlack1, K. Gürtler2, J. Zweigner2

1Praxis Jessen2, Private Clinic for Infectious Disease, Berlin, Germany, 2Institute for Microbiology and Hygiene, Charité- University Medicine, Berlin, Germany

Background: The incidence of acute syphilis has increased substantially in MSM. Stages of syphilis including neurosyphilis seem to be accelerated in patients co-infected with HIV. The serological differentiation between acute and persistent syphilis is often difficult because of an altered antibody decline despite an adequate antimicrobial treatment. The aim of this study was to elucidate the serological and clinical course of syphilis in a homogeneous group of MSM, being HIV-negative or HIV-positive, respectively.

Methods: Retrospective cohort study of all MSM with acute syphilis, treated within 3 years in a Private Clinic for Infectious Diseases. Serological and clinical data regarding syphilis and HIV infection were analyzed at the day of syphilis diagnosis and after 1, 3, 6 and 9 months. Different statistical tests were applied

Results: 216 patients (82 HIV-negative and 134 HIV-positive) were enrolled in the study. HIV-positive patients presented significant higher TPPA-, VDRL-, and IgM-titers at the day of diagnosing acute syphilis compared to the HIV-negative MSM. One month after diagnosis, TPPA- and VDRL- titers were still significantly higher in the HIV-positive group. HIV-positive patients presented significant more systemic syphilis symptoms including neurosyphilis in 8 cases as compared to 0 cases in the group of HIV-negative. In HIV-positive MSM TPPA-, VDRL- and IgM-titers were negatively correlated to the numbers of NK- and CD4+ cells at the onset of syphilis and 1 month later, respectively. In addition, a positive correlation between TPPA-, VDRL-, and IgM-titers to the numbers of CD4+ and CD8+ lymphocytes could be observed.after 1, 6, and 9 months, respectively.

Conclusion: HIV-positive MSM suffering from acute syphilis demonstrated a stronger immune response and higher risk for neurosyphilis as compared to HIV-negative MSM. Correlation of TPPA-, VDRL- and IgM-concentrations to parameters of the cellular immune response could be observed in HIV+ and possibly used for further differentiation of syphilis stages.

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