A Primary Care Intervention to Increase HIV Pre-Exposure Prophylaxis (PrEP) Uptake in Patients with Syphilis

Identifying candidates for HIV pre-exposure prophylaxis (PrEP) is a barrier to improving PrEP uptake in priority populations. Syphilis infection is an indication for PrEP in all individuals and can be easily assessed by primary care providers (PCP) and health systems. This retrospective study evaluated the impact of a multidisciplinary provider outreach intervention on PrEP uptake in patients with a positive syphilis test result in a safety-net hospital-based primary care practice. The PCPs of PrEP-eligible patients with a positive syphilis result were notified via the electronic medical record (EMR) about potential PrEP eligibility and institutional HIV PrEP resources. Rates of PrEP offers and prescriptions were compared in the pre (8/1/2018-12/31/2018, n = 60) and post (1/1/2019-5/31/2019, n = 86) intervention periods. Secondary analyzes evaluated receipt of appropriate syphilis treatment and contemporaneous screening for HIV, gonorrhea, and chlamydia. No significant differences in the overall proportion of patients offered (15% vs 19%) and prescribed (7% vs 5%) PrEP were observed between the pre- and post-periods. Overall, 7% of positive tests represented infectious syphilis. The rate of appropriate syphilis treatment was equivalent (57% vs 56%) and contemporaneous screening for other sexually transmitted infections was suboptimal across the entire study period. Although any positive syphilis test may be an easily abstracted metric from the EMR, this approach was inclusive of many patients without current HIV risk and did not increase PrEP uptake significantly. Future research into population health approaches to increase HIV prevention should focus on patients with infectious syphilis and other current risk factors for incident HIV infection.

1349. How Anchored is the Chancre? A Chart Review of Syphilis Treatment by a Safety Net Emergency Department in Atlanta, GA

Background Since reaching its nadir in 2000, syphilis has re-emerged as a public health threat in the U.S. The incidence of syphilis is disproportionately high in Atlanta, the epicenter of the HIV epidemic in the U.S. South. Given that syphilis infection is a strong predictor of HIV infection, identifying patients with syphilis is an important and underutilized method for connecting patients to HIV prevention and care services. Emergency departments (EDs) act as a critical access point to care in safety net health systems. We describe the recognition and empiric treatment of syphilis in the ED of Grady Healthcare System, a safety net hospital serving Atlanta. Methods We performed a retrospective chart review on all reactive rapid plasma reagin (RPR) tests collected from patients 18 years and older at the Grady ED from 5/1/20 to 10/31/20. We abstracted reported reason for testing, diagnosis, treatment administered, and location of treatment from the electronic health record. Results From 5/1/20 to 10/31/20, 148 patients with reactive RPR tests were identified. Reasons for testing were broad and included the evaluation of neurologic symptoms (47), genital/anal lesions (31), and a history of syphilis (18) (Table 1). 74 patients had presumed active syphilis (50%), 34 had previously treated syphilis (23%), 12 had false positives (8%), and 28 had an unclear diagnosis (19%) (Table 2). Of those with presumed primary syphilis who were discharged from the ED, 53% (8/15) received empiric treatment in the ED; 59% (10/17) of those with secondary syphilis received empiric treatment prior to discharge. Of the patients discharged from the ED, clinical follow up was indicated for 52% (31/59) given lack of empiric treatment or of confirmed prior treatment. Contact was attempted for 39% (12/31), but only 29% (9/31) were ultimately treated at Grady. Table 1: Abstracted Reasons for Testing for Syphilis in the ED For ED patients from 5/1/20-10/31/20 who had reactive RPRs, reasons for syphilis testing were taken from the chief complaint, history, or medical decision making documentation of ED providers, admitting providers, or consultants. Table 2: Syphilis Diagnoses of ED patients with reactive RPRs ED patients with a positive RPR from 5/1/20-10/31/20 were chart reviewed to determine their diagnosis. Previous RPR, treponemal antibodies, CSF results, media images, progress notes, and descriptions by medical staff were reviewed to attempt to retroactively determine the most likely syphilis diagnosis. Conclusion Reactive RPRs were common in this acute care setting and most represented active syphilis infection. Empiric treatment was most likely to be provided for patients with clear syphilis syndromes. However, a majority of patients who were discharged without empiric treatment did not receive follow up. Institutional protocols for following up reactive tests after discharge represent an opportunity to connect patients with syphilis treatment and HIV prevention services. Disclosures All Authors: No reported disclosures

Diagnosis, Treatment, and Prognosis of Syphilis in HIV Patient

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum (T. Palladium). Human Immunodeficiency Virus (HIV) is a virus that attacks the body's immune system, decreased the number of CD4 cells that makes the immune system decrease, and facilitates syphilis infection. Syphilis increased the risk of spreading HIV infection with skin barrier destruction. The diagnosis of syphilis is made based on a complete history, including sexual history, clinical manifestations, and examination. The treatment of syphilis with HIV and without HIV similar, penicillin is still the gold standard for syphilis treatment with HIV. Prevention of syphilis with HIV are educated, screening for syphilis and other sexually transmitted infections, as well as early detection and therapy of partners. The prognosis for syphilis in HIV is worse than for syphilis without HIV.

Syphilis treatment with listohepolem

Ritter (Derm. Woch., 1923, No. 36) in 43 cases of syphilis used intramuscular injections of bismogenol'n (German preparation Bi).

EVALUATION OF THE QUALITY OF LIFE OF PATIENTS WITH SYPHILIS TREATMENT AT THE CENTRAL HOSPITAL OF DERMATOLOGY

Quality of life is a widely used concept to measure the results of treatment of patients in general and patients with genital warts in particular. To provide data on the quality of life of warts patientstreated at the National Hospital of Dermatology, as a basis for improving the quality of treatment, we conducted this study to: Describe the quality of life. Survival of patients with warts treated at the National Hospital of Dermatology. This is a cross-sectional descriptive study. Information was collected through interviews with 210 patients with warts treated at the National Hospital of Dermatology (December 6, 2020) using the QE-5D-5L quality of life measurement tool kit. Research results show that the quality of life is quite and good accounted for 57.6% with a quality of life score of 0.9910 ± 0.058, an average quality of life is quite good at 36.2% with a quality of life score of 0.729 ± 0.048, mean quality of life is 2.9%with quality of life score of 0.533 ± 0.043, patients with poor quality of life account for 3.3% of quality of life, which is 0.288 ± 0.101.

Epilepsy and syphilis: A systematic review and meta-analysis

Background: Epileptic seizures were noted as one of the most overlooked manifestations in syphilis; therefore a few clinicians are concerned about the relationship between epilepsy and syphilis. Our study sought to clarify the prevalence and clinical features of epileptic seizures in patients with syphilis. Methods: We retrieved relevant articles from different databases, using the keywords “syphilis and epilepsy” and then performed statistical analysis to characterize the relationship between these diseases. Results: Forty one articles were included in this study: eight described the prevalence of syphilis and epilepsy and the remaining 33 were case reports on syphilis with epileptic seizures. The meta-analysis included 1252 patients with syphilis. The pooled estimate of proportion of prevalence (95% confidence interval) was 0.1384 (0.0955–0.2005), and the proportion and heterogeneity showed different degrees of change among three subgroups. The systematic review included 46 cases of syphilis with epileptic seizures. Thirty two (80%) patients had motor seizures, among whom 20 (62.5%) had tonic-clonic seizures. In addition, 30 (75%) patients had impaired awareness and 18 (45%) had status seizures. Twenty five (62.5%) patients were 35–55 years of age, and 77.5% of the included patients were men. Thirty seven (97.4%) patients were seizure-free after anti-syphilis treatment. Limitations: Research in this field has been conducted for a relatively short period and publication bias may exist. Furthermore, some patients with syphilis and epileptic seizures may not have recieved a clear diagnosiss. Conclusion: The proportion of prevalence was 0.1384. Most of the included patients were 35–55 years of age and had impaired awareness and motor seizures. Many patients with syphilis and epileptic seizure showed full recovery or the development of minor neurological sequelae, and nearly all patients were seizure-free after timely anti-syphilis treatment.

A case series with literature review on adjunctive usage of intravitreal ceftazidime in ocular syphilis with human immunodeficiency virus infection

Background: Penicillin is the conventional treatment for all stages of syphilis, including ocular and neurosyphilis, according to the recommendations by the Centre for Disease Control and Prevention Sexually Transmitted Disease. This case series highlighted three cases of ocular syphilis which showed prompt treatment response as early as 24 h after the adjunctive intravitreal ceftazidime injection. Methods: Case Series. Results: In case 1, there was significant improvement in the vision and vitritis after 24 h of a single intravitreal ceftazidime injection. In case 2, the patient achieved his best vision after a total of three intravitreal injections in his left eye and one in his right eye. In case 3, there was a further resolution of perivascular sheathing and retinal haemorrhages seen 1 week after a single intravitreal ceftazidime injection. Conclusion: The efficacy of intravitreal ceftazidime injection as a local adjunctive therapy in ocular syphilis treatment is noteworthy. It can be considered in cases which show suboptimal or slower treatment response despite early commencement of systemic penicillin to prevent devastating ocular sequelae.