I. Moreira

Syphilis and HIV coinfection: Indications for lumbar puncture at Instituto de Infectologia Emílio Ribas, Brazil

Background: Sexually transmitted infections (STIs), particularly genital ulcer diseases (GUD) are a neglected field in health care, partly due to the stigma associated with the diseases. Coinfection with HIV alters the clinical presentation, natural history and response to treatment. Moreover, STIs contribute significantly to increased risk of HIV transmission. Management of STIs at primary health care level is syndromic, driven by algorithms. In the absence of interest and expertise at secondary/tertiary care centres patients, who fail this management, suffer. Methods &Materials: We present a retrospective chart review of patients referred to our a specialist Infectious Diseases Unit with challenging or unusual STI/GUD,who did not respond to syndromic management. Results: We have closely documented 42 patients (23 male, 39 HIV positive) seen at King Edward VIII hospital for STI/GUD. The patients had an average of 2.6 different primary health care providers (range: 1-5) before coming to the tertiary site. Only 54.8% were formally referred. 15patientshadextensive chronicHSVulcers (8males, allHIV+ ). Of these, 7 responded to high doses of acyclovir (400mg 8 hourly to 800mg 5 times daily). Duration of treatment varied from 7 to 21 days. 6 chronic HSV ulcers (4 males) failed high dose acyclovir but responded to topical imiquimod treatment. Of 13 patients (9 males) with extensive condylomata acuminata (warts) 4 underwent curative circumcision and 9 required extensive ablation. 5 of the latter (3 males) had squamous cell carcinomas. All were managed syndromically as STIs for >18 months. 4 patients had chronic genital ulcers with no discernible cause and very low CD4 counts. These ulcers healed completely after commencement of anti-retroviral treatment. Onemale with penile abscesses and multiple urinary fistulas had trichomonas vaginalis repeatedly isolated and responded to a prolonged course of metronidazole. Other diagnoses included severe tinea cruris (4), lichen planus chronicus (2), papular pruritic eruptions (PPE) (1), penile pearly papules (PPP) (1), vitiligo (1). Conclusion: We need to develop expertise in the management of patients who do not respond to syndromic STI/GUS treatment and develop clear referral pathways to secondary and tertiary care centres with adequate facilities and investigative capacity for timeous diagnosis and intervention. This is particularly urgent in the context of HIV/AIDS.

Syphilis and HIV coinfection; Indications for lumbar puncture at Instituto de Infectologia Emilio Ribas, Brazil

M. Eira1, E. Boccardo1, R. J. Costa Silva1, I. Moreira1, L. Ouki1, U. Barbosa1, T. A. Matos2; 1Instituto de Infectologia Emílio Ribas, Outpatient clinic, Sao Paulo, SP/BR, 2Instituto de Infectologia Emílio Ribas, Clinical Laboratory, Sao Paulo/BR Background Sexually transmitted infections (STIs) among HIV-infected patients are a large global problem for public health systems. The recent resurgence of syphilis presents a challenge for all physicians, particularly when patients are coinfected with HIV/syphilis. The diagnosis of neurosyphilis (NS) is also a challenge, especially in coinfected patients, and the criteria for deciding when to perform a lumbar puncture (LP) in HIV-infected patients with syphilis are still controversial. The aim of this research was to assess the demographic and laboratory data including cerebrospinal fluid serological and biochemical abnormalities in HIV-infected subjects with secondary or late latent syphilis and serum VDRL ≥ 1:8. Methods & Materials We retrospectively reviewed demographic and laboratory data from 360 patients coinfected with HIV and syphilis who underwent a LP to rule out NS at the outpatient clinic of the Instituto de Infectologia Emílio Ribas (Brazil), between July 2012 and September 2013. Neurosyphilis was defined by white blood cell (WBC) counts >20cells/μL in the cerebrospinal fluid (CSF) sample or elevated Venereal Disease Research Laboratory (VDRL) titers of the CSF samples. Results Table 1: Clinical and laboratory features in HIV-infected patients with neurosyphilis. # 62.009