Effectiveness of syphilis treatment using azithromycin and/or benzathine penicillin in Rakai, Uganda

Mohammed G. Kiddugavu, Noah Kiwanuka, Maria J. Wawer, David Serwadda, Nelson K. Sewankambo, Fred Wabwire-Mangen, Fredrick Makumbi, Xianbin Li, Steven J. Reynolds, Thomas C. Quinn, Fred Nalugoda, Godfrey Kigozi, Pius Opendi, Thomas Lutalo, Sarah Kalibbala, Joseph Matovu, Noah Nyende, Mary Meehan, Margaret Nakalanzi, Ronald H. Gray

Research output: Contribution to journalArticlepeer-review

58 Scopus citations


Objective: The goal of this study was to assess azithromycin and/or benzathine penicillin for treatment of syphilis. Methods: In a population-based study, participants with serologic syphilis (TRUST with TPHA confirmation) were offered 2.4 MU benzathine penicillin intramuscularly. Intervention arm participants received 1 g presumptive oral azithromycin. We assessed cure rates with penicillin or azithromycin given alone and in combination. Cure assessed after 10 months was defined as seroreversion or a 4-fold decrease in titer. The rate ratio (RR) of cure and 95% confidence intervals (95% CIs) were estimated by log binomial regression. Results: Among 952 cases with syphilis, 18% received penicillin alone, 17% azithromycin only, and 65% dual treatment The overall cure rate was 61%. Cure rates were lower in males compared with females (RR, 0.89; 95% CI, 0.80-0.99) and in subjects with initial titers ≥1:4 compared with ≤1:2 (RR, 0.77; 95% CI, 0.69-0.86). There was no significant differences in cure rates among HIV-positive and HIV-negative persons. With initial titers ≤1:2, there were no differences in cure rates by treatment regimen. However, with initial titers ≥1:4, significantly higher cure rates were observed with azithromycin alone (adjusted RR, 1.38; 95% CI, 0.97-1.96), and with dual treatment of azithromycin and benzathine penicillin (RR, 138; 95% CI, 1.03-1.87) compared with penicillin alone. Conclusion: Azithromycin alone or in combination with penicillin achieved higher cure rates than penicillin alone in cases with a high initial TRUST titer. In low-liter infections, the 3 drug combinations were equally effective. HIV status did not affect cure rates.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalSexually transmitted diseases
Issue number1
StatePublished - Jan 2005
Externally publishedYes

ASJC Scopus subject areas

  • Dermatology
  • Public Health, Environmental and Occupational Health
  • Microbiology (medical)
  • Infectious Diseases


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