Determining the Prevalence of Neurosyphilis in a Cohort Co-Infected with HIV

Abstract

A retrospective study of 767 HIV positive patients from a large urban public hospital, 238 of whom were co-infected with syphilis, was performed to determine the prevalence of neurosyphilis. A prevalence of 3% of neurosyphilis in the co-infected cohort was demonstrated. The 7 cases of neurosyphilis ascertained were of the early stage variety, with cranial nerve involvement the predominant focal deficit. Of the 5 cases presenting after initial diagnosis and treatment of syphilis, 4 were felt to be inadequately treated. An overall prevalence of 1% (7/767) was determined for the entire HIV(+) cohort. The majority of the cases of syphilis (90%) were characterized as latent syphilis. Based on these findings, the authors recommend routine CSF examination in all patients who are HIV positive and who present with latent syphilis. Treatment regimens should be maximized in an effort to reduce the prevalence of neurosyphilis in such a co-infected cohort.

Syphilitic meningitis in HIV-patients with meningeal syndrome: report of two cases and review

“…Several studies have demonstrated that syphilis constitutes an independent risk factor for HIV infection and the risk seems to be a result of a breakdown in the mucocutaneous barrier due to genital ulceration [24,25]. The incidence of syphilis among HIV-infected individuals is difficult to estimate, but seroprevalence studies have shown evidence of previous exposure to T. pallidum in 3% to 35% HIV-seropositive patients [20,26,27]. A study conducted by Carmo, et al [28] in Belo Horizonte, Brazil (1998), using treponemal tests (EIA or FTA-Abs) showed a syphilis seroprevalence of 37.2% among 650 HIV-1-infected patients.…”

Experience of Meningovascular Syphilis in Human Immunodeficiency Virus Infected Patient

“…Treatment of syphilis in HIV positive people can be an important means of preventing HIV transmission. The incidence of syphilis among HIV-positive individuals is difficult to estimate, but seroprevalence studies have shown evidence of previous exposure to Treponema pallidum in 3% to 35% of HIV-positive patients 3,4,12) . Concurrent HIV infection may alter the progression of syphilis by increasing the propensity of the disease to progress to neurosyphilis, decreasing the latency period before the onset of neurosyphilis, increasing the severity of the manifestations of neurosyphilis, or rendering standard therapy for primary and secondary syphilis inadequate 13) .…”

Syphilis in adults

“…HIV infection can lead to larger or more numerous chancres, 4 5 accelerated ulcerating secondary syphilis, 6 frequent ocular syphilis, faster progression to late syphilis such as neurosyphilis and gummatous syphilis; the former have been reported mainly in those treated for early syphilis with single dose benzathine penicillin. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Although serological tests in HIV positive patients generally perform in the same way as in immunocompetent patients, it can occasionally behave unpredictably-for example, delayed positive serological tests in secondary syphilis. Biological false positives for cardiolipin tests (VDRL, RPR) and prozone phenomenon can also occur in HIV infection.…”