Background: Neurosyphilis (NS) is nowadays a less frequent disease. Its incidence and clinical spectrum have changed over time. Objective: To estimate the incidence of NS and describe the clinical spectrum of NS in immunocompetent patients in the last decade. Methods: Demographic and clinical features, cerebrospinal fluid (CSF) changes, neuroimaging findings and outcome were retrospectively analyzed. Results: Forty-three patients met NS criteria. The yearly incidence was 0.2– 2.1 cases per 100,000 inhabitants. The mean age was 48.1 years, males being more frequently involved. The most frequent clinical patterns were meningovascular (30.2%), meningeal (25.6%) and general paresis (25.6%). Compared to prepenicillin series, we observed a decrease in late forms, mainly tabes dorsalis. CSF titers studied by the Venereal Disease Research Laboratory were higher in early NS. Neuroimaging findings were nonspecific. Outcome was better for early forms. Conclusions: Compared to the preantibiotic era, a lower frequency of late NS was observed, similar to that reported in other modern series which include patients with HIV infection. Therefore, this trend seems to be due to the impact of antibiotics rather than to HIV infection.

Gjestland T: The Oslo study of untreated syphilis. An epidemiologic investigation of the natural course of the syphilitic infection based upon a re-study of the Boeck-Bruusgaard material. Acta Derm Venereol 1955;35(suppl 34):11–36.
Rowland LP: Spirochete infections: Neurosyphilis; in Rowland LP (ed): Merrit’s Textbook of Neurology. Baltimore, Williams and Wilkins, 1985, pp 200–208.
Solbrig MV, Healy JF, Jay CA: Infections of the nervous system: Bacterial infections; in Bradley WG, Daroff RB, Fenichel GM, Marsden CD (eds): Neurology in Clinical Practice. Boston, Butterworth Heinemann, 1999, pp 1317–1351.
De Schryver A, Meheus A: Epidemiology of sexually transmitted diseases: The global picture. Bull World Health Organ 1990;68:639–654.
Gerbase AC, Rowley JT, Mertens TE: Global epidemiology of sexually transmitted diseases. Lancet 1998;351(suppl 3):2–4.
Área de vigilancia epidemiológica, Centro Nacional de Epidemiología: Comentario epidemiológico de las enfermedades de declaración obligatoria y sistema de información microbiológica. España. Año 2000. Bol Epidemiol Sem 2001;9:101–105.
Área de vigilancia epidemiológica, Centro Nacional de Epidemiología: Incidencia de las enfermedades transmisibles de declaración obligatoria, casos y tasas por 100.000 habitantes a nivel provincial/CCAA. España. Año 2000. Bol Epidemiol Sem 2001;9:106–107.
Hooshmand H, Escobar MR, Kopf SW: Neurosyphilis. A study of 241 patients. JAMA 1972;219:726–729.
Burke JM, Schaberg DR: Neurosyphilis in the antibiotic era. Neurology 1985;35:1368–1371.
Wolters EC: Neurosyphilis: A changing diagnostic problem? Eur Neurol 1987;26:23–28.
Flood JM, Weinstock HS, Guroy ME, Bayne L, Simon RP, Bolan G: Neurosyphilis during the AIDS epidemic, San Francisco, 1985–1992. J Infect Dis 1998;177:931–940.
Johns DR, Tierney M, Felsestein D: Alteration in the natural history of neurosyphilis by concurrent infection with de human immunodeficiency virus. N Engl J Med 1987;316:1569–1572.
Tibbling G, Link H, Ohman S: Principles of albumin and IgG analyses in neurological disorders. Scand J Clin Lab Invest 1977;37:385–390.
Kierland RR, O’Leary PA, Van Doren E: Symptomatic neurosyphilis. J Vener Dis Inf 1942;22:360–377.
Merritt HH, Adams RD, Solomon HC: Neurosyphilis. New York, Oxford University Press, 1946.
Wolters EC: Neurosyphilis: A changing diagnostic problem? Eur Neurol 1987;26:23–28.
Katz DA, Berger JR, Duncan RC: Neurosyphilis: A comparative study of the effects of infection with human immunodeficiency virus. Arch Neurol 1993;50:243–249.
Musher DM, Hasmill RJ, Baughn RE: Effect of human immunodeficiency virus HIV infection on the course of syphilis and on the response to treatment. Ann Intern Med 1990;113:872–881.
Dowell ME, Ross PG, Musher DM, Cate TR, Baugh RE: Response of latent syphilis or neurosyphilis to ceftriaxone therapy in persons infected with human immunodeficiency virus. Am J Med 1992;93:481–488.
Gordon SM, Eaton ME, George R, Larsen S, Lukehart SA, Kuypers J, et al: The response of symptomatic neurosyphilis to high-dose intravenous penicillin G in patiens with human immunodeficiency virus infection. N Engl J Med 1994;331:1469–1473.
Hicks CB, Benson PM, Lupton GP, Tramont EC: Seronegative secondary syphilis in a patient infected with the human immunodeficiency virus (HIV) with Kaposi sarcoma. A diagnostic dilemma. Ann Intern Med 1987;107:492–495.
Tikjob G, Russel M, Petersen CS, Gerstoft J, Kobayasi T: Seronegative secondary syphilis in a patient with AIDS: Identification of Treponema pallidum in biopsy specimen. J Am Acad Dermatol 1991;24:506–508.
Feraru ER, Aronow HA, Lipton RB: Neurosyphilis in AIDS patients: Initial CSF VDRL may be negative. Neurology 1990;40:541–543.
Hook EW, Marra CM: Acquired syphilis in adults. N Engl J Med 1994;326:1060–1069.
Golden MR, Marra CM, Holmes KK: Update on syphilis, resurgence of an old problem. JAMA 2003;290:1510–1514.
Davis LE, Schmitt JW: Clinical significance of cerebrospinal fluid test for neurosyphilis. Ann Neurol 1989;25:50–55.
Simon RP: Neurosyphilis. Arch Neurol 1985;42:606–613.
Hook EW 3rd: Syphilis; in Scheld WM, Whitley RJ, Durack DT (eds): Infections of the Central Nervous System. Philadelphia, Lippincott-Raven, 1997, pp 669–684.
Cosottini M, Mascalchi M, Zaccara G, Arnetoli G: Reversal of syphilitic hydrocephalus with intravenous penicillin. Can J Neurol Sci 1997;24:343–344.
Pao D, Goh BT, Binham JS: Management issues in syphilis. Drugs 2002;62:1447–1461.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.