Oral doxycycline as an alternative treatment for early neurosyphilis in a patient living with HIV

Authors

  • Bruno Pereira Conte Conte Universidade Franciscana - Santa Maria - Rio Grande do Sul - Brasil
  • Roberta Letsch da Silveira Universidade do Planalto Catarinense - Lages - Santa Catarina - Brasil
  • Fabio Lopes Pedro Universidade Federal de Santa Maria - Santa Maria - Rio Grande do Sul - Brasil
  • Jerusa Marquardt Corazza Universidade Federal de Santa Maria - Santa Maria - Rio Grande do Sul - Brasil
  • Fernanda Caldeira Veloso Santos Universidade Federal de Santa Maria - Santa Maria - Rio Grande do Sul - Brasil

DOI:

https://doi.org/10.5935/2764-734X.e20240947

Keywords:

Neurosyphilis, HIV infections, Doxycycline, Case report

Abstract

This report aims to describe the successful treatment using oral doxycycline for early neurosyphilis in a patient living with HIV, primarily presenting with skin lesions. The therapeutic proposal, chosen by the patient and based on UK medical guidelines, has not yet been validated by the Brazilian Ministry of Health. The treatment consisted of a single dose of penicillin G benzathine (2.4 million units) administered intramuscularly, followed by oral doxycycline (200 mg twice a day) for 28 days, with quarterly outpatient follow-up. The patient's symptoms resolved on the first visit, and the nontreponemal test (VDRL) in the cerebrospinal fluid was negative after 6 months. The current literature offers inconclusive results; however, this case suggests that oral doxycycline is a safe alternative for treating neurosyphilis in select cases, especially for patients with penicillin allergies, while providing the advantage of avoiding hospitalization.

References

1. Avelleira JCR, Bottino G. Sífilis: diagnóstico, tratamento e controle. An Bras Dermatol. 2006;81(2):111-26. DOI: 10.1590/S0365-05962006000200002

2. Chan DJ. Syphilis and HIV co-infection: when is lumbar puncture indicated? Curr HIV Res. 2005;3(1):95-8. DOI: 10.2174/1570162052773031

3. Ceccarelli G, Borrazzo C, Lazzaro A, Innocenti GP, Celani L, Cavallari EN, et al. Diagnostic Issues of Asymptomatic Neurosyphilis in HIV-Positive Patients: A Retrospective Study. Brain Sci. 2019;9(10):278. DOI: 10.3390/brainsci9100278

4. Girometti N, Junejo MH, Nugent D, McOwan A, Whitlock G; 56 Dean Street Collaborative Group. Clinical and serological outcomes in patients treated with oral doxycycline for early neurosyphilis. J Antimicrob Chemother. 2021;76(7):1916-9. DOI: 10.1093/jac/dkab100

5. Janier M, Unemo M, Dupin N, Tiplica GS, Potočnik M, Patel R. 2020 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol. 2021;35(3):574-88. DOI: 10.1111/jdv.16946

6. Brasil. Ministério da Saúde. Protocolo Clínico e Diretrizes para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis [Internet]. Brasília: Ministério da Saúde; 2022; [Accessed in 2024 June 23]. Available from: http://antigo.aids.gov.br/pt-br/pub/2022/protocolo-clinico-e-diretrizes-terapeuticas-para-atencao-integral-pessoas-com-infeccoes

7. Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. DOI: 10.15585/mmwr.rr7004a1

8. Kingston M, French P, Higgins S, McQuillan O, Sukthankar A, Stott C, et al. UK national guidelines on the management of syphilis 2015. Int J STD AIDS. 2016;27(6):421-46. DOI: 10.1177/0956462415624059

9. Qin J, Yang T, Wang H, Feng T, Liu X. Potential Predictors for Serofast State after Treatment among HIV-Negative Persons with Syphilis in China: A Systematic Review and Meta-Analysis. Iran J Public Health. 2015;44(2):155-69.

10. Li J, Zheng HY. Early syphilis: serological treatment response to doxycycline/tetracycline versus benzathine penicillin. J Infect Dev Ctries. 2014;8(2):228-32. DOI: 10.3855/jidc.3013

11. Peyriere H, Makinson A, Marchandin H, Reynes J. Doxycycline in the management of sexually transmitted infections. J Antimicrob Chemother. 2018;73(3):553-63. DOI: 10.1093/jac/dkx420

12. Lewis DA, Lukehart SA. Antimicrobial resistance in Neisseria gonorrhoeae and Treponema pallidum: evolution, therapeutic challenges and the need to strengthen global surveillance. Sex Transm Infect. 2011;87(Suppl 2):ii39-43. DOI: 10.1136/sti.2010.047712

13. Araujo RS, Souza ASS, Braga JU. Who was affected by the shortage of penicillin for syphilis in Rio de Janeiro, 2013-2017? Rev Saude Publica. 2020;54:109. DOI: 10.11606/s1518-8787.2020054002196

14. Bettuzzi T, Jourdes A, Robineau O, Alcaraz I, Manda V, Molina JM, et al. Ceftriaxone compared with benzylpenicillin in the treatment of neurosyphilis in France: a retrospective multicentre study. Lancet Infect Dis. 2021;21(10):1441-7. DOI: 10.1016/S1473-3099(20)30857-4

15. Clement ME, Okeke NL, Hicks CB. Treatment of Syphilis. JAMA. 2014;312(18):1905-17. DOI: 10.1001/jama.2014.13259

16. Ghanem KG, Erbelding EJ, Cheng WW, Rompalo AM. Doxycycline compared with benzathine penicillin for the treatment of early syphilis. Clin Infect Dis. 2006;42(6):e45-9. DOI: 10.1086/500406

Downloads

Published

2024-11-27

How to Cite

Conte, B. P. C., Silveira, R. L. da, Pedro, F. L., Corazza, J. M., & Santos, F. C. V. (2024). Oral doxycycline as an alternative treatment for early neurosyphilis in a patient living with HIV. Infections in Evidence, 3, e20240947. https://doi.org/10.5935/2764-734X.e20240947

Issue

Vol. 3 (2024)

Section

Case Reports

License

Copyright (c) 2025 Infections in Evidence

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

The Copyright Transfer Agreement assumes that the authors are the legitimate holders of the copyright of the Case Report in question, without infringing any copyright, trademark or patent of others. In this way, they transfer all rights to this manuscript or any revision, version or translation of it to the Journal, including here the exclusivity of its eventual commercialization, provided that in accordance with ethical and moral precepts and relevant Brazilian legislation. All articles in the INFECTIONS IN EVIDENCE Journal are published under the terms of international license 4.0 of the Creative Commons Attribution, which allows users to freely read, download, share and adapt cultural and scientific productions, provided that due credit is given to the original authors and publication.
The Copyright Transfer Agreement also understands that the authors guarantee that the respective Case Report has never been published in another communication vehicle or scientific journal. Papers presented at meetings and/or scientific congresses may be published in the electronic journal INFECTIOUS DISEASES IN EVIDENCE - Case Reports, provided that they have not been published in whole or in part in their Proceedings or Annals.