The Treatment of Neurosyphilis in Patients With HIV Infection

Fernández-Guerrero, Manuel L.; Miranda, C; Cenjor, Carlos; Sanabria, Francisco

doi:10.1001/jama.1988.03720100017015

Cited by 19 publications

(7 citation statements)

References 6 publications

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“…10,12,14,[16][17][18][19][20]22,41 Among previous reports of HIV-positive patients with otosyphilis, subjective improvement occurred in 10 of 13 patients (76.9%) for whom outcomes were reported. [25][26][27][28][29][30][31][32] In a previous study of 48 patients with otosyphilis, those patients with profound hearing loss at initiation of treatment were the least likely to experience improvement. 17 Although, the relationship between the duration of symptoms of auditory syphilis and success of treatment is unclear, in our series, the four patients with the shortest duration of symptoms experienced the greatest improvement in hearing.…”

Section: Discussionmentioning

confidence: 97%

“…Of published cases for which the results of CSF investigations were reported, 42% had abnormal findings diagnostic of concomitant neurosyphilis. 13,15,19,20,22,23,[25][26][27][31][32][33][34][35] CSF examination is recommended for all patients with syphilis and neurological or ocular signs or symptoms, regardless of stage of disease. 5,36 As well, among HIV-positive patients with syphilis, CSF examination is recommended in late latent syphilis or latent syphilis of unknown duration.…”

Section: Discussionmentioning

confidence: 99%

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Otosyphilis in HIV-Coinfected Individuals: A Case Series from Toronto, Canada

Mishra

Walmsley

Loutfy

et al. 2008

AIDS Patient Care and STDs

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We sought to identify and review the clinical features and treatment outcomes of eight recent cases of otosyphilis in HIV-positive patients seen in Toronto. All patients reported tinnitus, and seven (87.5%) reported subjective hearing loss. Not taking auditory findings into consideration, four patients would be classified as having secondary syphilis, three patients as having early latent syphilis, and one patient as having latent syphilis of unknown duration. The median CD4 cell count was 370 x 10(6)/L. All patients were treated with intravenous aqueous penicillin G with regimens recommended for the treatment of neurosyphilis; four patients received adjunctive steroids. All eight patients experienced improvement in tinnitus and four of the seven (57.1%) patients with symptomatic hearing loss also experienced improvement. Otosyphilis can occur in HIV-positive individuals despite high CD4 cell counts, and is potentially reversible. Increased awareness of uncommon manifestations of syphilis in high-risk individuals is warranted to prompt appropriate investigation and treatment.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Otosyphilis in HIV-Coinfected Individuals: A Case Series from Toronto, Canada

Mishra

Walmsley

Loutfy

et al. 2008

AIDS Patient Care and STDs

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“…Although most HIV-infected persons who also are infected with T. pallidum appear to respond normally in the serologic tests for syphilis and have typical clinical signs (63,169), several exceptions have been published (38,108,162) or reported to the CDC. The problems in the diagnosis of syphilis are (i) confusing clinical signs and symptoms (38,162); (ii) lack of serologic response in a patient with a clinically confirmed case of active syphilis (64,72); (iii) failure of nontreponemal test titers to decline after treatment with standard regimens; (iv) unusually high titers in nontreponemal tests (140), perhaps as the result of B-cell activation (107); (v) rapid progression to late stages of syphilis and neurologic involvement even after treatment of primary or secondary syphilis (6,50,91,98,120,140); and (vi) the disappearance of treponemal test reactivity over time (67). Whether these problems in the diagnosis of syphilis occur more frequently in HIV-seropositive persons than in HIVseronegative persons with syphilis is unclear (169,171).…”

Section: Figmentioning

confidence: 99%

Laboratory diagnosis and interpretation of tests for syphilis

1995

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The lack of a method for demonstrating the presence of Treponema pallidum by growth necessitates the use of alternative methods. Traditionally, these methods are divided into direct detection methods (animal inoculation, dark-field microscopy, etc.) and serologic tests for the presence of patient antibody against T. pallidum. Serologic methods are further divided into two classes. One class, the nontreponemal tests, detects antibodies to lipoidal antigens present in either the host or T. pallidum; examples are the Venereal Disease Research Laboratory and rapid plasma reagin and tests. Reactivity in these tests generally indicates host tissue damage that may not be specific for syphilis. Because these tests are easy and inexpensive to perform, they are commonly used for screening, and with proper clinical signs they are suggestive of syphilis. The other class of test, the treponemal tests, uses specific treponemal antigens. Confirmation of infection requires a reactive treponemal test. Examples of the treponemal tests are the microhemagglutination assay for antibodies to T. pallidum and the fluorescent treponemal antibody absorption test. These tests are more expensive and complicated to perform than the nontreponemal tests. On the horizon are a number of direct antigen, enzyme-linked immunosorbent assay, and PCR techniques. Several of these techniques have shown promise in clinical trials for the diagnosis of congenital syphilis and neurosyphilis that are presently difficult to diagnose.

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“…There have been several reports (reviewed in reference'P') of neurosyphilis occurring after appropriate therapy in normal hosts. HIV-infection has undoubtedly increased awareness, probably also the frequency, of a phenomenon that was already recognized 185 . The more prolonged treatments used in the UK may tip the synergistic balance in favour of the host with regard to elimination of T. pallidum, even in those patients with an immunological deficit.…”

Section: Neurosyphilismentioning

confidence: 99%

Syphilis: New Diagnostic Directions

Young

1992

Int J STD AIDS

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The Treatment of Neurosyphilis in Patients With HIV Infection

Cited by 19 publications

References 6 publications

Otosyphilis in HIV-Coinfected Individuals: A Case Series from Toronto, Canada

Otosyphilis in HIV-Coinfected Individuals: A Case Series from Toronto, Canada

Laboratory diagnosis and interpretation of tests for syphilis

Syphilis: New Diagnostic Directions

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