Predicting asymptomatic neurosyphilis using peripheral blood indicators

Abstract

Background The high misdiagnosis rate of asymptomatic neurosyphilis (ANS) has long challenged infectious disease clinicians. We aim to develop a model for diagnosing ANS in asymptomatic syphilis (AS) patients without CSF indicators. Results 277 AS patients with HIV-negative and underwent lumbar puncture were enrolled in this horizontal study.The area under the curve for predicting ANS by CSF leukocytes and protein was 0.643 and 0.675 [95% CI, 0.583–0.699VS.0.616–0.729]. Through LRM, the AUC increased to 0.806 [95% CI, 0.732–0.832], and the Youden's index was 0.430. If the score is ≤ 0.159, ANS can be excluded with a predictive value of 92.9%; we can identify ANS while the score is over 0.819, with a predictive value of 91.7% and a specificity of 99.25%. This study showed that the LRM can diagnose ANS in AS patients effectively. Conclusion Given a large number of misdiagnosis ANS patients and CSF results' insufficiency, the model is more practical. Our research will help clinicians track suspected syphilis, especially those who cannot accept the CSF test.

Serum Interleukin-26 is a Potential Biomarker for the Differential Diagnosis of Neurosyphilis and Syphilis at Other Stages

“…However, etiological and serological detection of syphilis in CSF is not commonly performed before the patient shows obvious symptoms of neurosyphilis due to the disadvantages and patient nonacceptance of lumbar puncture, which results in patients missing the opportunity for early antipsychotic treatment. We were inspired by a model study of the prediction of asymptomatic neurosyphilis based on routine blood tests, lymphocyte subsets, serum immunological results and other peripheral blood indicators without using CSF indicators 24 and expected to find noninvasive neurosyphilis-specific screening biomarkers.…”

Impact of Asymptomatic Neurosyphilis on Patients Quality of Life and Social Stigma

“…1,2 Syphilis, also called the "great imitator", can have various symptoms, making diagnosis difficult. 3,4 Syphilis is treated with antibiotics; 5 however, if it is not treated on time and the Treponema pallidum invades the nervous system, it leads to neurosyphilis. 1,2 Neurosyphilis usually occurs about 10 to 20 years after being first infected with syphilis.…”

“…Symptomatic neurosyphilis is characterized by abnormalities in the way of walking, numbness in the lower extremities, thinking problems, headaches, urinary incontinence. 4 Although the prevalence of asymptomatic neurosyphilis (ANS) is unknown, some studies stated that its prevalence is 13.5% of patients with syphilis, 4 does not present any symptoms, but there is still inflammation, damage, and blood abnormalities that are typical of syphilis, such as anemia, thrombocytopenia, leukopenia, or leukocytosis. 6 In addition, because it does not show symptoms, it is usually diagnosed quite late, and therefore the treatment is also usually late.…”

“…This can result in long-term neurological complications and the development of more serious entities that become symptomatic. 4,[6][7][8] Although ANS patients do not have symptoms, but they may suffer from stigma, shame, 9 and social exclusion mainly due to two reasons. On the one hand, they are categorized as people with a sexually transmitted disease, which is associated with disgust, shame, depression, anxiety, worry, and feelings of being less loved.…”

“…In addition, a high percentage of patients with syphilis also have HIV, 5,10,11 which adds to the emotional and social burden of the patient. 4 On the other hand, they can be categorized as patients with mental problems because if patients with ANS are late-diagnosed or not well treated, 4 they can develop symptomatic neurosyphilis, which makes them susceptible to mental illness. 1,2,12,13 Also, it has been reported that when patients feel stigma, it will affect the treatment and prognosis of the disease due to less cooperation and social maladaptation, bringing a double burden to physical and psychological health.…”