BACKGROUND: The rise in serious complications of early syphilis, including neurosyphilis, particularly in those with HIV infection and in men who have sex with men (MSM), is of concern. OBJECTIVES: To review the manifestations and management of neurosyphilis in a population of HIV-infected MSM. METHODS: Retrospective review of patients with HIV and early neurosyphilis in three centres in Melbourne, Australia, in 2000-07. RESULTS: Eighteen male HIV patients met the criteria for diagnosis of early neurosyphilis. Thirteen patients (72.2%) had neurological symptoms: six with headache (33.3%), four with tinnitus (22.2%) and five with impaired vision (27.8%), and one patient each with ataxia, leg weakness and anal discharge with faecal incontinence. Five patients (27.8%) reported no neurological symptoms. All had serum rapid plasma reagin (RPR) titres ≥1:32 and all except one had cerebrospinal fluid positive for syphilis fluorescent treponemal antibodies-absorbed. After treatment with 14-15 days of 1.8 g intravenous benzylpenicillin 4-hourly, 12 of 17 patients (71%) demonstrated a four-fold drop in serum RPR titre over 6-12 months and were considered successfully treated. A rise in RPR was noted in three patients during the 12-month follow-up period, suggesting re-infection or recurrence. CONCLUSION: HIV-infected patients found to have syphilis either because of symptoms or by routine screening should be carefully assessed for neurological, ophthalmic and otological symptoms and signs. A low threshold for a diagnostic lumbar puncture to exclude the diagnosis of neurosyphilis enables appropriate administration and dose of penicillin for treatment, which appears successful in ~75% of cases.
BACKGROUND: The rise in serious complications of early syphilis, including neurosyphilis, particularly in those with HIV infection and in men who have sex with men (MSM), is of concern. OBJECTIVES: To review the manifestations and management of neurosyphilis in a population of HIV-infected MSM. METHODS: Retrospective review of patients with HIV and early neurosyphilis in three centres in Melbourne, Australia, in 2000-07. RESULTS: Eighteen male HIVpatients met the criteria for diagnosis of early neurosyphilis. Thirteen patients (72.2%) had neurological symptoms: six with headache (33.3%), four with tinnitus (22.2%) and five with impaired vision (27.8%), and one patient each with ataxia, leg weakness and anal discharge with faecal incontinence. Five patients (27.8%) reported no neurological symptoms. All had serum rapid plasma reagin (RPR) titres ≥1:32 and all except one had cerebrospinal fluid positive for syphilis fluorescent treponemal antibodies-absorbed. After treatment with 14-15 days of 1.8 g intravenous benzylpenicillin 4-hourly, 12 of 17 patients (71%) demonstrated a four-fold drop in serum RPR titre over 6-12 months and were considered successfully treated. A rise in RPR was noted in three patients during the 12-month follow-up period, suggesting re-infection or recurrence. CONCLUSION:HIV-infectedpatients found to have syphilis either because of symptoms or by routine screening should be carefully assessed for neurological, ophthalmic and otological symptoms and signs. A low threshold for a diagnostic lumbar puncture to exclude the diagnosis of neurosyphilis enables appropriate administration and dose of penicillin for treatment, which appears successful in ~75% of cases.
Authors: Pedro Martínez-Ayala; Alejandro Quiñonez-Flores; Luz Alicia González-Hernández; Vida Verónica Ruíz-Herrera; Sergio Zúñiga-Quiñones; Guillermo Adrián Alanis-Sánchez; Rodolfo Ismael Cabrera-Silva; Fernando Amador-Lara; Karina Sánchez-Reyes; Monserrat Álvarez-Zavala; Juan Carlos Vázquez-Limón; Juan Pablo Sánchez-Navarro; Jaime Federico Andrade-Villanueva Journal: Int J STD AIDS Date: 2022-01-03 Impact factor: 1.359