(PL15) CHARACTERIZATION OF THE JARISCH-HERXHEIMER REACTION AFTER BENZATHINE PENICILLIN G TREATMENT IN EARLY SYPHILIS

Wednesday, September 18, 2024

4:15 PM - 5:15 PM EST

Primary Author(s)

Jodie A. Dionne, MD, MSPH

Director of Infection in Women and Pregnancy Research Program
University of Alabama at Birmingham, Alabama, United States

Co-Author(s)(s)

Arlene C. Sena, MD MPH (she/her/hers)

Professor of Medicine
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina, United States
CM

Candice J. McNeil, MD, MPH

Associate Professor
Wake Forest University School of Medicine, North Carolina, United States
CP

Charlotte Perlowski, MSPH, CCRP

Senior Clinical Research Manager
FHI 360
CZ

Chunming Zhu, PhD

EMMES
EH

Edward Hook, MD

University of Alabama at Birmingham (UAB)
Julie Dombrowski, MD, MPH (she/her/hers)

Professor
University of Washington, United States
Jorge E. Mejia-Galvis, MD (he/him/his)

Physician. Medical Officer
National Institutes of Health
KM

Ken Mayer, MD

Fenway Health
Kimberly Workowski, MD

Professor of Medicine, Division of Infectious Diseases
Emory University
Atlanta, Georgia, United States
Matthew M. Hamill, MBChB, PhD

Assistant Professor of Medicine
Department of Medicine, The Johns Hopkins University
Baltimore, Maryland, United States
Stephanie Taylor, MD

Professor of Medicine
Louisiana State University School of Medicine
New Orleans, Louisiana, United States
TB

Theresa Batteiger, MD

Indiana University
HW

Harold Wiesenfeld, MD

UPMC, United States

Background:
The Jarisch-Herxheimer reaction (JHR) describes a set of signs and symptoms that can occur shortly after antibiotic treatment of active disseminated Treponema pallidum (syphilis). The reported prevalence of JHR following penicillin treatment in patients with early syphilis ranges from 8-56%.

Methods:
We designed this study to characterize the prevalence, duration, and severity of JHR signs and symptoms among well-characterized adults enrolled in a multicenter randomized clinical trial (RCT) with active early syphilis after treatment with benzathine penicillin G (BPG). We also sought to confirm an association between JHR and treatment response to BPG at six months. Finally, we created unadjusted and adjusted models to assess whether participant-level factors were associated with JHR.

Results:
Among study participants (n=249) with untreated early syphilis enrolled from ten US sites, 97.2% (242/249) were assigned male sex at birth and 61% (153/249) were living with HIV. A total of 23.7% (59/249) experienced at least one symptom consistent with JHR after treatment with BPG. When stratified by HIV status, people living with HIV (PWLH) had lower rates of symptomatic JHR (19.6% vs 31.9% in people without HIV). The most frequently reported symptoms included: myalgias (59%), chills (48%), weakness (39%), feverishness (36%), and headache (29%). Median time to onset of symptoms was 4.9 hours and BPG treatment response rate at six months was 73%. Treatment response rates were higher in the group with JHR (85% vs 69% in the group without JHR) and secondary syphilis stage was associated with JHR.

Conclusion:
In this prospective observational study, JHR was documented in one in four people following treatment with BPG. People living with HIV had lower JHR rates after treatment. Commonly reported symptoms included myalgias and chills and median duration was <24 hours. BPG treatment response at six months was higher in the group with JHR.