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Peer-reviewedCC BYInternational Journal of Infectious Diseases

Comparative effectiveness of three benzathine penicillin G-based regimens in people with HIV who presented with early syphilis

  • Kai-Hsiang Chen1
  • Hsin-Yun Sun2
  • Kuan-Yin Lin2
  • Yu-Shan Huang2
  • Sung-Hsi Huang3
  • Wang-Da Liu4
  • Yi-Chia Huang2
  • Tzong-Yow Wu5
  • Yu-Chung Chuang2
  • Aristine Cheng2
  • Li-Hsin Su2
  • Chien-Ching Hung6
6 affiliations
  1. 1Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
  2. 2Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
  3. 3Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan; Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
  4. 4Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
  5. 5Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
  6. 6Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Corresponding author.
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Abstract

Objectives: To compare 12-month serologic responses to three benzathine penicillin G (BPG)-based regimens among people with HIV (PWH) and early syphilis. Methods: We retrospectively included syphilis episodes treated with BPG, BPG plus 7-day doxycycline (BPG/doxycycline), or BPG/doxycycline plus single-dose ceftriaxone during 2018-2024. Episodes with baseline rapid plasma reagin (RPR) titers <1:4 or exposure to other Treponema pallidum -active antibiotics were excluded. Serologic response was defined as a ≥ 4-fold RPR decline at 12 months. Intention-to-treat (ITT) with last-observation-carried-forward and per-protocol analyses were performed. Results: Among 1077 episodes in 762 PWH, 453 received BPG, 570 BPG/doxycycline, and 54 BPG/doxycycline/ceftriaxone. ITT response rates were 74.6%, 83.2%, and 88.9%, respectively ( P < 0.001); per-protocol rates were 74.4%, 83.4%, and 89.8% ( P < 0.001). Higher baseline RPR titers and doxycycline-containing regimens were independently associated with response. In analyses directly comparing BPG/doxycycline with and without ceftriaxone, adding ceftriaxone to BPG/doxycycline was not significantly associated with a higher serologic response. Conclusions: BPG/doxycycline was associated with a higher likelihood of 12-month serologic response. The incremental association of ceftriaxone remained uncertain because of the small number of ceftriaxone-treated episodes.

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Cite

BibTeXRIS
BibTeX
@article{chen2026comparative,
  title = {{Comparative effectiveness of three benzathine penicillin G-based regimens in people with HIV who presented with early syphilis}},
  author = {Kai-Hsiang Chen and Hsin-Yun Sun and Kuan-Yin Lin and Yu-Shan Huang and Sung-Hsi Huang and Wang-Da Liu and Yi-Chia Huang and Tzong-Yow Wu and Yu-Chung Chuang and Aristine Cheng and Li-Hsin Su and Chien-Ching Hung},
  journal = {International Journal of Infectious Diseases},
  year = {2026},
  month = oct,
  doi = {10.1016/j.ijid.2026.109069},
  url = {https://doi.org/10.1016/j.ijid.2026.109069},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Comparative effectiveness of three benzathine penicillin G-based regimens in people with HIV who presented with early syphilis
AU  - Kai-Hsiang Chen
AU  - Hsin-Yun Sun
AU  - Kuan-Yin Lin
AU  - Yu-Shan Huang
AU  - Sung-Hsi Huang
AU  - Wang-Da Liu
AU  - Yi-Chia Huang
AU  - Tzong-Yow Wu
AU  - Yu-Chung Chuang
AU  - Aristine Cheng
AU  - Li-Hsin Su
AU  - Chien-Ching Hung
PY  - 2026
DA  - 2026/10/30
JO  - International Journal of Infectious Diseases
DO  - 10.1016/j.ijid.2026.109069
UR  - https://doi.org/10.1016/j.ijid.2026.109069
AB  - Objectives: To compare 12-month serologic responses to three benzathine penicillin G (BPG)-based regimens among people with HIV (PWH) and early syphilis. Methods: We retrospectively included syphilis episodes treated with BPG, BPG plus 7-day doxycycline (BPG/doxycycline), or BPG/doxycycline plus single-dose ceftriaxone during 2018-2024. Episodes with baseline rapid plasma reagin (RPR) titers <1:4 or exposure to other Treponema pallidum -active antibiotics were excluded. Serologic response was defined as a ≥ 4-fold RPR decline at 12 months. Intention-to-treat (ITT) with last-observation-carried-forward and per-protocol analyses were performed. Results: Among 1077 episodes in 762 PWH, 453 received BPG, 570 BPG/doxycycline, and 54 BPG/doxycycline/ceftriaxone. ITT response rates were 74.6%, 83.2%, and 88.9%, respectively ( P < 0.001); per-protocol rates were 74.4%, 83.4%, and 89.8% ( P < 0.001). Higher baseline RPR titers and doxycycline-containing regimens were independently associated with response. In analyses directly comparing BPG/doxycycline with and without ceftriaxone, adding ceftriaxone to BPG/doxycycline was not significantly associated with a higher serologic response. Conclusions: BPG/doxycycline was associated with a higher likelihood of 12-month serologic response. The incremental association of ceftriaxone remained uncertain because of the small number of ceftriaxone-treated episodes.
SN  - 1201-9712
SN  - 1878-3511
ER  -