Syphilis has reemerged as an important cause of neurological disease, affecting any part of the neuraxis at any stage of infection. What was once a dwindling diagnosis is now redoubling, particularly in the HIV-positive and in men who have sex with men populations. In the era of antibiotics and HIV coinfection, neurosyphilis presentations are protean, making diagnosis notoriously challenging. Advanced disease may be irreversible, and so early detection and treatment are ideal. Herein, we review recent advances in understanding neurosyphilis.
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a chronic pain syndrome identified by the presence of noninfectious pelvic or perineal pain lasting longer than 3 months. Current diagnoses and treatments for the syndrome solely depend on and target symptoms, respectively. Thus far, the mechanistic disturbances responsible for the pathogenesis of CP/CPPS have remained largely elusive and treatments, and therefore, continue to be ineffective. To move toward successful management and treatment of CP/CPPS, it is necessary to elicit the underlying biological mechanisms responsible for the syndrome. Therefore, a phenotyping system that is able to bridge the gap between current symptom-based diagnosis and future mechanistic approaches to diagnosis and treatment is needed. In this article, we examine current CP/CPPS phenotyping systems, analyze their utility, and make suggestions for changes in clinical approaches to the syndrome that would both promulgate a mechanistic understanding and advance treatment approaches.
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