Neurosyphilis and the impact of HIV infection

Abstract

Abstract. Neurosyphilis is a complication of systemic syphilis. This review of the clinical presentation, diagnostic laboratory findings, treatment and management of neurosyphilis discusses the impact of HIV and the specific challenges it brings, focusing on areas of controversy, and highlighting important questions that remain to be answered.

Neurosyphilis in patients with HIV

“…The clinical manifestations of neurosyphilis are similarly varied, and patients may remain asymptomatic for years. Levels of central neurological involvement can be classified into meningeal, vascular or parenchymatous forms with direct invasion of T. pallidum possible at each of these sites 9. Meningeal and vascular neurosyphilis are inflammatory processes that frequently coexist (meningovascular neurosyphilis), particularly in the early years of infection 10.…”

“…Meningeal and vascular neurosyphilis are inflammatory processes that frequently coexist (meningovascular neurosyphilis), particularly in the early years of infection 10. Meningeal involvement can present as aseptic meningitis with symptoms such as headache, photophobia and neck stiffness and can lead to complications such as cranial nerve palsies 9. Vascular syphilis can affect the arterial supply of the brain or spinal cord resulting in ischaemic stroke and, depending on the arterial territory involved, can cause different neurological deficits.…”

“…Vascular syphilis can affect the arterial supply of the brain or spinal cord resulting in ischaemic stroke and, depending on the arterial territory involved, can cause different neurological deficits. Neurosyphilis should therefore always be considered as a differential diagnosis in any patient with ischaemic stroke of unknown cause, particularly in young people 9. Parenchymal neurosyphilis is neurodegenerative in nature and can manifest as general paresis—characterised by memory deficit, emotional lability and psychosis—or tabes dorsalis (also known as syphilitic myelopathy) in which patients may develop sensory ataxia and neuropathic pain in the lower limbs 11 12.…”

The role of Point-of-Care testing in the diagnosis of syphilis

“…Studies have also shown that syphilis has been associated with an increased risk of HIV transmission and acquisition [2,3]. Neurosyphilis may also develop earlier in the course of the disease in HIV-infected patients [4][5][6][7][8].…”

Syphilis: a fresh look at an old foe

“…17,18 Ho and Spudich delve into the complex area of neurosyphilis and critically review its diagnosis and management in the context of HIV, including the thorny issue of when lumbar punctures are indicated. 19 Turning to the biology of T. pallidum, Ma et al detail the typing methods that have been used to characterise different strains and make a case for the development of more discriminatory genotyping methods. 20 These would potentially pave the way for typing that would have clinical utility such as information on the source of infection and predicting treatment response.…”