Symptomatic and asymptomatic early neurosyphilis in HIV-infected men who have sex with men: a retrospective case series from 2000 to 2007
Christina C. Chang A , David E. Leslie B , Denis Spelman A , Kyra Chua C , Christopher K. Fairley D E , Alan Street C , Suzanne M. Crowe A F and Jennifer F. Hoy A G
+ Author Affiliations
- Author Affiliations
A Infectious Diseases Unit, The Alfred Hospital and Department of Medicine, Monash University, Vic. 3004, Australia.
B Victorian Infectious Diseases Reference Laboratory, Carlton South, Vic. 3053, Australia.
C Infectious Diseases Unit, Royal Melbourne Hospital, Parkville, Vic. 3050, Australia.
D Melbourne Sexual Health Clinic, Carlton, Vic. 3053, Australia.
E School of Population Health, University of Melbourne, Vic. 3053, Australia.
F Burnet Institute, Melbourne, Vic. 3004, Australia.
G Corresponding author. Email: jennifer.hoy@med.monash.edu.au
Sexual Health 8(2) 207-213 https://doi.org/10.1071/SH10060
Submitted: 25 May 2010 Accepted: 6 October 2010 Published: 18 May 2011
Abstract
Background: The rise in serious complications of early syphilis, including neurosyphilis, particularly in those with HIV infection and in men who have sex with men (MSM), is of concern. Objectives: To review the manifestations and management of neurosyphilis in a population of HIV-infected MSM. Methods: Retrospective review of patients with HIV and early neurosyphilis in three centres in Melbourne, Australia, in 2000–07. Results: Eighteen male HIV patients met the criteria for diagnosis of early neurosyphilis. Thirteen patients (72.2%) had neurological symptoms: six with headache (33.3%), four with tinnitus (22.2%) and five with impaired vision (27.8%), and one patient each with ataxia, leg weakness and anal discharge with faecal incontinence. Five patients (27.8%) reported no neurological symptoms. All had serum rapid plasma reagin (RPR) titres ≥1 : 32 and all except one had cerebrospinal fluid positive for syphilis fluorescent treponemal antibodies-absorbed. After treatment with 14–15 days of 1.8 g intravenous benzylpenicillin 4-hourly, 12 of 17 patients (71%) demonstrated a four-fold drop in serum RPR titre over 6–12 months and were considered successfully treated. A rise in RPR was noted in three patients during the 12-month follow-up period, suggesting re-infection or recurrence. Conclusion: HIV-infected patients found to have syphilis either because of symptoms or by routine screening should be carefully assessed for neurological, ophthalmic and otological symptoms and signs. A low threshold for a diagnostic lumbar puncture to exclude the diagnosis of neurosyphilis enables appropriate administration and dose of penicillin for treatment, which appears successful in ~75% of cases.
Additional keywords: asymptomatic neurosyphilis, sexually transmissible infection, syphilis.
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