Open forum infectious diseases · 2026
Penicillin or Ceftriaxone for Neurosyphilis in People With HIV: A Retrospective, Propensity Score-Matched Multicenter Study in Mexico.
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Ville Benavides Rodrigo, Rivera-Villegas Héctor, Ocampo-Valdez Obed, Franco-Cendejas Rafael, Andrade-Villanueva Jaime Federico, González-Hernández Luz Alicia, Martínez-Ayala Pedro, Cárdenas-Ortega Andrea, Carreño-Pérez Paulina, Lezama-Mora Jezer, Rodríguez-Aldama Juan Carlos, Pérez-Barragán Edgar, Alatorre-Fernández Pamela, Sienra-Iracheta Estefanía, Rodríguez-Zulueta Ana Patricia, Rivera-Martínez Norma Eréndira, Crabtree-Ramírez Brenda
Аннотация
BACKGROUND: Neurosyphilis, ocular syphilis, and otosyphilis occur more frequently among people with HIV-1 and are associated with higher morbidity and treatment failure. Intravenous penicillin G remains the standard therapy but requires hospitalization or prolonged intravenous access, creating barriers that are amplified in resource-limited settings facing recurrent penicillin shortages. Ceftriaxone is a potential alternative; however, comparative data in people with HIV are limited.
METHODS: We conducted a multicenter retrospective cohort study of adults with HIV at 5 public hospitals and 2 outpatient HIV clinics in Mexico (2015-2024). Participants had confirmed neurosyphilis, ocular syphilis, or otosyphilis. Participants received intravenous penicillin G (18-24 million IU/day) or ceftriaxone (1-2 g/day) for 10-14 days. The primary outcome was early serological response (ESR), defined as a ≥4-fold nontreponemal titer decline or seroreversion at 6 months. We performed 1:1 propensity score matching (39 pairs, n = 78), followed by logistic regression in the matched cohort.
RESULTS: Of 143 participants, 104 (73%) received intravenous penicillin G and 39 (27%) ceftriaxone. In the matched cohort, ESR occurred in 74.4% of penicillin-treated participants and 71.8% of ceftriaxone-treated participants (odds ratio 0.88, 95% confidence interval .32-2.40; P = .80). The results were consistent across all prespecified sensitivity analyses.
CONCLUSIONS: In this multicenter cohort of people with HIV diagnosed with neurosyphilis, ocular syphilis, or otosyphilis, ceftriaxone showed comparable ESR to intravenous penicillin G. These findings support ceftriaxone as a reasonable alternative when standard therapy is limited by penicillin shortages, limited inpatient capacity, or financial constraints.
METHODS: We conducted a multicenter retrospective cohort study of adults with HIV at 5 public hospitals and 2 outpatient HIV clinics in Mexico (2015-2024). Participants had confirmed neurosyphilis, ocular syphilis, or otosyphilis. Participants received intravenous penicillin G (18-24 million IU/day) or ceftriaxone (1-2 g/day) for 10-14 days. The primary outcome was early serological response (ESR), defined as a ≥4-fold nontreponemal titer decline or seroreversion at 6 months. We performed 1:1 propensity score matching (39 pairs, n = 78), followed by logistic regression in the matched cohort.
RESULTS: Of 143 participants, 104 (73%) received intravenous penicillin G and 39 (27%) ceftriaxone. In the matched cohort, ESR occurred in 74.4% of penicillin-treated participants and 71.8% of ceftriaxone-treated participants (odds ratio 0.88, 95% confidence interval .32-2.40; P = .80). The results were consistent across all prespecified sensitivity analyses.
CONCLUSIONS: In this multicenter cohort of people with HIV diagnosed with neurosyphilis, ocular syphilis, or otosyphilis, ceftriaxone showed comparable ESR to intravenous penicillin G. These findings support ceftriaxone as a reasonable alternative when standard therapy is limited by penicillin shortages, limited inpatient capacity, or financial constraints.