Background: The incidence of HIV-syphilis co-infection has risen since 2000, especially among men having sex with men (MSM). Syphilis reinfection can occur, but the clinical features of such events remain poorly characterized. Objective: To compare the cutaneous lesions seen with syphilis reinfections with those of first episodes in HIV-infected patients. Methods: In a cohort of HIV-infected patients, syphilis reinfection was established both clinically and biologically by evaluating changes in Venereal Disease Research Laboratory titers. Photographs and medical records were studied in order to determine the type of skin lesions and their quantification. Results: Among 533 HIV-infected patients, 42 (8%) experienced a first syphilis infection. Thirteen episodes of reinfection occurred in 12/42 (28%) patients, all MSM. In 78% of cases, reinfections were less symptomatic than first episodes. All patients presented classical syphilis lesions. Conclusions: We observed a high rate of reinfection, but with less severe skin manifestations during reinfection episodes.

Keywords:
Immunization, Sexually transmitted diseases, Syphilis, Sexual behavior
1.
Pathela P, Braunstein SL, Schillinger JA, Shepard C, Sweeney M, Blank S: Men who have sex with men have a 140-fold higher risk for newly diagnosed HIV and syphilis compared with heterosexual men in New York City. J Acquir Immune Defic Syndr 2011;58:408-416.
2.
Brewer TH, Peterman TA, Newman DR, Schmitt K: Reinfections during the Florida syphilis epidemic, 2000-2008. Sex Transm Dis 2011;38:12-17.
3.
Ogilvie GS, Taylor DL, Moniruzzaman A, Knowles L, Jones H, Kim PH, Rekart ML: A population-based study of infectious syphilis rediagnosis in British Columbia, 1995-2005. Clin Infect Dis 2009;48:1554-1558.
4.
Phipps W, Kent CK, Kohn R, Klausner JD: Risk factors for repeat syphilis in men who have sex with men, San Francisco. Sex Transm Dis 2009;36:331-335.
5.
Cohen SE, Chew Ng RA, Katz KA, Bernstein KT, Samuel MC, Kerndt PR, Bolan G: Repeat syphilis among men who have sex with men in California, 2002-2006: implications for syphilis elimination efforts. Am J Public Health 2012;102:e1-e8.
6.
Stokes JH, Schoch AG, Ireland FA: The clinical concept of reinfection in syphilis: a critique based on five cases, the reported literature and a study of early relapse. Arch Derm Syphilol 1931;23:829-855.
7.
Wigfield AS: Immunological phenomena of syphilis. Br J Vener Dis 1965;41:275-285.
8.
Engelkens HJ, ten Kate FJ, Judanarso J, Vuzevski VD, van Lier JB, Godschalk JC, van der Sluis JJ, Stolz E: The localisation of treponemes and characterisation of the inflammatory infiltrate in skin biopsies from patients with primary or secondary syphilis, or early infectious yaws. Genitourin Med 1993;69:102-107.
9.
Morgan CA, Lukehart SA, Van Voorhis WC: Protection against syphilis correlates with specificity of antibodies to the variable regions of Treponema pallidum repeat protein K. Infect Immun 2003;71:5605-5612.
10.
Grassly NC, Fraser C, Garnett GP: Host immunity and synchronized epidemics of syphilis across the United States. Nature 2005;433:417-421.
11.
Workowski KA, Berman S; Centers for Disease Control and Prevention (CDC): Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010;59(RR-12):26-36.
12.
Grange PA, Gressier L, Dion PL, Farhi D, Benhaddou N, Gerhardt P, Morini JP, Deleuze J, Pantoja C, Bianchi A, Lassau F, Avril MF, Janier M, Dupin N: Evaluation of a PCR test for detection of Treponema pallidum in swabs and blood. J Clin Microbiol 2012;50:546-552.
13.
Branger J, van der Meer JT, van Ketel RJ, Jurriaans S, Prins JM: High incidence of asymptomatic syphilis in HIV-infected MSM justifies routine screening. Sex Transm Dis 2009;36:84-85.
14.
Hutchinson CM, Rompalo AM, Reichart CA, Hook EW 3: Characteristics of patients with syphilis attending Baltimore STD clinics. Multiple high-risk subgroups and interactions with human immunodeficiency virus infection. Arch Intern Med 1991;151:511-516.
15.
Rolfs RT, Joesoef MR, Hendershot EF, Rompalo AM, Augenbraun MH, Chiu M, Bolan G, Johnson SC, French P, Steen E, Radolf JD, Larsen S: A randomized trial of enhanced therapy for early syphilis in patients with and without human immunodeficiency virus infection. The Syphilis and HIV Study Group. N Engl J Med 1997;337:307-314.
16.
Knaute DF, Graf N, Lautenschlager S, Weber R, Bosshard PP: Serological response to treatment of syphilis according to disease stage and HIV status. Clin Infect Dis 2012;55:1615-1622.
17.
Nadelman RB, Hanincová K, Mukherjee P, Liveris D, Nowakowski J, McKenna D, Brisson D, Cooper D, Bittker S, Madison G, Holmgren D, Schwartz I, Wormser GP: Differentiation of reinfection from relapse in recurrent Lyme disease. N Engl J Med 2012;367:1883-1890.
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2015
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