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Otologic manifestations of AIDS: the otosyphilis connection
1Division of Head and Neck Surgery (Otolaryngology), Harbor-UCLA Medical Center, Torrance 90509.
Abstract:
Five cases of otosyphilis presenting in patients with HIV infection are discussed. The group is representative of the known stages of the disease, from asymptomatic carrier to the fully expressed immunodeficiency syndrome, and it is of relevance because otosyphilis appears to have developed at an accelerated rate from the primary infection. Four patients had been treated with penicillin 2 to 5 years previously and had a positive fluorescent treponemal antibody absorption (FTA-ABS) test. The fifth had concurrent neurosyphilis and was VDRL-test (Venereal Disease Research Laboratory) negative 2 years prior to the onset of symptoms. In all five patients, syphilis was in the latent stage. It is proposed that it is during this phase of the disease that HIV may alter its course and hasten the development of otosyphilis. It is also suggested that otosyphilis can present at any stage of HIV infection and should be considered in seropositive patients presenting with otologic complaints.
Insights
Human immunodeficiency virus (HIV) infection may accelerate the development of otosyphilis, a syphilis complication affecting the ear. Otosyphilis should be considered in HIV-positive patients with ear symptoms.
Area of Science:
- Infectious Diseases
- Neurology
- Otolaryngology
Background:
- Otosyphilis, a manifestation of syphilis affecting the ear, can occur at any stage of Human Immunodeficiency Virus (HIV) infection.
- Previous penicillin treatment does not preclude the development of otosyphilis in HIV-infected individuals.
Observation:
- Five cases of otosyphilis in patients with HIV infection are presented, representing various stages of immunodeficiency.
- Four patients had received prior penicillin treatment and tested positive on the fluorescent treponemal antibody absorption (FTA-ABS) test.
- One patient presented with concurrent neurosyphilis and a negative Venereal Disease Research Laboratory (VDRL) test two years prior.
Findings:
- Syphilis was latent in all five patients at the time of otosyphilis diagnosis.
- HIV infection may accelerate the progression from primary syphilis to otosyphilis.
- Otosyphilis can manifest during any phase of HIV infection.
Implications:
- Clinicians should consider otosyphilis in HIV-seropositive patients experiencing otologic complaints.
- The interplay between HIV and syphilis may alter the typical course of syphilis progression.
- Early consideration of otosyphilis is crucial for timely diagnosis and management in this patient population.