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July 25, 1994

The Prozone Phenomenon in Syphilis Associated With HIV Infection-Reply

Author Affiliations

Decatur, Ga

Arch Intern Med. 1994;154(14):1644. doi:10.1001/archinte.1994.00420140115017

The letter by Haslett and Laverty describes a new clinical setting for the occurrence of the prozone phenomenon. The authors mention that the unexpected rapid decline of the original titer should have aroused some suspicion. We recently saw a very similar case. Our patient was human immunodeficiency virus positive, with a CD4 lymphocyte count of 0.02×109/L and an original rapid plasma reagin titer of 1:2048 in March 1993. For his neurosyphilis (cerebrospinal VDRL was positive at a titer of 1:64) and coexistent bacterial endocarditis (group G Streptococcus), he received a 4-week treatment with penicillin, 3×103 U intravenously every 4 hours. On follow-up 3 months later, his rapid plasma reagin titer was reported as nonreactive. On routine follow-up 6 months later, his rapid plasma reagin titer was again positive, with a titer of 1:2048. Unfortunately, the second specimen was not available for testing. The importance of the prozone

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