A Consequence of the Syphilis Epidemic Among Men Who Have Sex With Men (MSM): Neurosyphilis in Los Angeles, 2001–2004

Taylor, Melanie; Aynalem, Getahun; Olea, Leanne M.; He, Peter; Smith, Lisa V.; Kerndt, Peter R.

doi:10.1097/olq.0b013e3181644b5e

Cited by 87 publications

(67 citation statements)

References 15 publications

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“…Some studies indicate that HIV-infected individuals may have more significant symptoms of neurosyphilis (72), and HIV-infected individuals who have symptomatic neurosyphilis have more severe CSF abnormalities (70,73). Treatment of HIV-infected patients with antiretroviral therapy (ART) decreases the chance of developing neurosyphilis by 65% (70), suggesting that immune reconstitution with ART may result in an improved local immune response against T. pallidum and better control of the infection.…”

Section: The Natural History Of Syphilis Primary Syphilis -Transmissimentioning

confidence: 99%

Syphilis: using modern approaches to understand an old disease

Lukehart²

2011

J. Clin. Invest.

201

168

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Syphilis is a fascinating and perplexing infection, with protean clinical manifestations and both diagnostic and management ambiguities. Treponema pallidum subsp. pallidum, the agent of syphilis, is challenging to study in part because it cannot be cultured or genetically manipulated. Here, we review recent progress in the application of modern molecular techniques to understanding the biological basis of this multistage disease and to the development of new tools for diagnosis, for predicting efficacy of treatment with alternative antibiotics, and for studying the transmission of infection through population networks.

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Section: The Natural History Of Syphilis Primary Syphilis -Transmissimentioning

confidence: 99%

Syphilis: using modern approaches to understand an old disease

Lukehart²

2011

J. Clin. Invest.

201

168

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“…pallidum, is one of the most feared complications of syphilis. For epidemiological and possibly immunological reasons (1,2), NS is now more commonly seen in patients infected with HIV than it was previously (3)(4)(5), and a significant proportion of these cases occur during the early phase of infection (6). The criteria for deciding when to perform a lumbar puncture (LP) in HIV-infected patients with syphilis are controversial.…”

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confidence: 98%

Clinical Prediction and Diagnosis of Neurosyphilis in HIV-Infected Patients with Early Syphilis

et al. 2013

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The diagnosis of neurosyphilis (NS) is a challenge, especially in HIV-infected patients, and the criteria for deciding when to perform a lumbar puncture (LP) in HIV-infected patients with syphilis are controversial. We retrospectively reviewed demographic, clinical, and laboratory data from 122 cases of HIV-infected patients with documented early syphilis who underwent an LP to rule out NS, and we evaluated 3 laboratory-developed validated real-time PCR assays, the Treponema pallidum particle agglutination (TPPA) assay, the fluorescent treponemal antibody absorption (FTA-ABS) assay, and the line immunoassay INNO-LIA Syphilis, for the diagnosis of NS from cerebrospinal fluid (CSF) samples of these patients. NS was defined by a reactive CSF-VDRL test result and/or a CSF white blood cell (WBC) count of >20 cells/l. Thirty of the 122 patients (24.6%) had early NS. Headache, visual symptoms, a CD4 cell count of <500 cells/l, and viremia, as defined by an HIV-1 RNA count of >50 copies/ ml, were associated with NS in multivariate analysis (P ‫؍‬ <0.001 for each factor). Blood serum rapid plasma reagin (RPR) titers were not associated with early NS (P ‫؍‬ 0.575). For the diagnosis of NS, the PCR, FTA-ABS, TPPA, and INNO-LIA assays had sensitivities of 58%, 100%, 68%, and 100%, specificities of 67%, 12%, 49%, and 13%, and negative predictive values of 85%, 100%, 84%, and 100%, respectively. Visual disturbances, headache, uncontrolled HIV-1 viremia, and a CD4 cell count of <500 cells/l were predictors of NS in HIV-infected patients with early syphilis, while blood serum RPR titers were not; therefore, RPR titers should not be used as the sole criterion for deciding whether to perform an LP in early syphilis. When applied to CSF samples, the INNO-LIA Syphilis assay easily helped rule out NS.

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“…9 The estimated incidence of symptomatic neurosyphilis among HIV-infected persons with early syphilis was found to be 3-4 times higher (2.1% vs 0.6%) as compared with HIV-negative persons. 10 Although believed to be rare, neurosyphilis should be part of the initial diagnostic workup of an atypical and rapidly progressive dementia. It should be considered in the differential diagnosis of diseases mimicking HSV and limbic encephalitides.…”

mentioning

confidence: 99%