Early symptomatic neurosyphilis and ocular syphilis: A comparative study between HIV-positive and HIV-negative patients

Abstract

Objectives: Since the 2000s, there has been an increase in prevalence of neurosyphilis (NS) and ocular syphilis (OS). As data about symptomatic NS/OS is limited, this study aims to assess the characteristics of symptomatic NS/OS, according to HIV status. Methods: We compared the clinical and biological presentation of early symptomatic NS/OS and its outcome in HIV-positive and HIV-negative patients. Results: Ninety-six patients (93% men, 49% HIV-positive) were included from 2000 to 2016 in two centers, with 67 (69%) having OS, 15 (16%) NS, and 14 (14%) both. HIV-positive patients were younger (P = 0.006) and more likely to be males having sex with males (P = 0.00048) or to have a history of syphilis (P = 0.01). Among 81 OS, there were 43 posterior uveitis (57%), and bilateral involvement was more common in HIV-positive patients (62% versus 38%, P = 0.045). Among 29 NS there were 21 cases of cranial nerve involvement (72%), seven meningitis (24%) and 11 paresthesia (38%). Involvement of the VIII th cranial nerve was the most common (16 cases). Treponemal tests were more commonly found positive in cerebrospinal fluid in HIV-positive patients (88% versus 76%, P = 0.04). Visual acuity (VA) always improved after treatment (initial VA logMAR 0.8 ± 0.8 versus 0.1 ± 0.1 at 3 months), but 32% and 18% of the patients still had neurological or ocular impairment respectively six and 12 months after treatment. Non-treponemal serological reversion was observed in 43/50 patients (88%) at six months. Conclusion: HIV infection has no consequence on the outcome of NS and OS. Sequelae are common, emphasizing the importance of prevention, and screening, and questioning enhanced treatment.

Clinical Features of Syphilis Patients with Ocular Symptoms as the Initial Manifestation

“… 19 According to a study by Rasoldier et al, there was a statistically significant increase in the numbers of Treponema antibodies in the CSF of patients with co-existing HIV and syphilis. 20 Therefore, HIV testing is essential for patients diagnosed with syphilitic uveitis. In our patient group, no cases of complicated HIV were observed; however, HIV testing was not carried out in two patients who declined examination.…”

Ocular vs neurosyphilis. are they the same? A guide to investigation and management

“…A small number of infected patients develop late asymptomatic neurosyphilis that resolves, while an even smaller number of these patients go on to develop debilitating symptomatic late neurosyphilis. HIV co-infection does not increase the risk of neurosyphilis, but may accelerate the course of infection with the mean age of neurosyphilis diagnosis being younger in HIV infected patients, a finding not present in all forms of syphilis [10,42,43].…”

“…Symptomatic patients with early neurosyphilis present with headache and meningism. Further clinical manifestations at this stage are cranial nerve palsies (often multiple), ocular or otic involvement [33,43].…”

Human Immunodeficiency Virus and Uveitis

“…In contrast, anterior uveitis is more common among HIV-negative patients with syphilis [ 27 ]. Chorioretinitis and bilateral involvement are also more common in syphilitic uveitis than in general uveitis [ 27 , 32 , 38 , 39 , 40 ]. Serological testing is useful for diagnosing syphilitic uveitis, while patients with HIV might need more time to respond to the test [ 41 ].…”