Syphilis and other sexually transmitted diseases in HIV infection

An ongoing resurgence of syphilis and continued transmission of other common sexually transmitted diseases (STDs) in HIV-infected patients is fueled by a number of factors, including "prevention burnout" resulting from fatigue with long-term, safer-sex behavior, use of recretional drugs (notably methamphetamine), and false sense of security associated with HIV serosorting and elevated CD4+ cell count. Annual screening for common STDs is recommended for HIV-infected patients. Issues in syphilis and herpes simplex virus-2 (HSV-2) diagnosis and treatment are discussed. New problems are briefly reviewed, which include the increased reporting of lymphogranuloma venereum and the increased frequency of fluoroquinolone-resistant gonorrhea. The recently revised Centers for Disease Control and Prevention guidelines for treatment of syphilis, HSV-2 infection, chlamydial infection, and gonorrhea are summarized. This article summarizes a presentation on syphilis and other STDs made by Jeanne Marrazzo, MD, MPH, at the International AIDS Society-USA Continuing Medical Education course in New York, in October 2006. The original presentation is available as a Webcast at www.iasusa.org.