Published: 2021-11-22

A case report on penicillin/co-trimoxazole induced Jarisch Herxheimer reaction in secondary syphilis with human immunodeficiency virus

Suruthi Lakshmi Narayanan, Afsal Ahammed, Arun Chander Yadav Krishnamurthy


The Jarisch-Herxheimer reaction (JHR) typically occurs after the initiation of antibiotic treatment in syphilis. Although JHR was identified and looked at over many years, the prevention and management of JHR remain unclear. Previous reports have described the occurrence of JHR due to antibiotic treatment in syphilis, we presented a case of a young man with recurrence of JHR in syphilis, first due to penicillin which later was worsened due to co-trimoxazole.


Antibiotic treatment, Jarisch-Herxheimer, Syphilis, Penicillin, Co-trimoxazole

Full Text:



Pound MW, May DB. Proposed mechanisms and preventative options of Jarisch-Herxheimer reactions. J Clin Pharm Ther. 2005;30(3):291-5.

Butler T. The Jarisch-Herxheimer reaction after antibiotic treatment of spirochetal infections: a review of recent cases and our understanding of pathogenesis. Am J Trop Med Hyg. 2017;96(1):46-52.

Belum GR, Belum VR, Arudra SKC, Reddy BS. The Jarisch-Herxheimer reaction: revisited. Travel Med Infect Dis. 2013;11(4):231-7.

Clement ME, Okeke NL, Hicks CB. Treatment of syphilis: a systematic review. JAMA. 2014;312(18):1905-17.

Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187.

Tsai MS, Yang CJ, Lee NY, Hsieh SM, Lin YH, Sun HY, et al. Jarisch-Herxheimer reaction among HIV-positive patients with early syphilis: azithromycin versus benzathine penicillin G therapy. J Int AIDS Soc. 2014;17:18993.

McKenzie C, Olges J. Jarisch-Herxheimer reaction after cephalosporin administration in syphilis. Cureus. 2021;13(1):12750.

Elias A, Wark K, Slape D, Cook D, Lee K, Mckew G. Secondary syphilis with eosinophilia complicated by severe Jarisch-Herxheimer reaction. Case Rep Infect Dis. 2020;2020:2150314.