Clinical features and teratment of neurosyphilis in a public hospital, Callao 1997-2007

Abstract

Objectives. To describe clinical features, cerebrospinal fluid (CSF) changes, and therapy of patients with neurosyphilis (NS). Material and methods. This is a retrospective study including patients older than 14 years who met criteria for defining a confirmed or probable case of neurosyphilis according to the Centers for Disease Control and Prevention (CDC) and who were admitted to a public hospital in Callao, Peru, between 1997 and 2007. Results. Twenty-five patients met criteria for defining NS (22 for confirmed cases and 3 for probable cases). Median age was 40 years, 24 patients (96%) were men, four (16%) had a past history of syphilis, and 15 (60%) had HIV infection. Twenty-one patients (84%) developed symptomatic NS, of which fourteen (67%) had early forms, and this pattern was most commonly seen in HIV-infected patients (p=0.001). Of those patients with CSF data available, 64% (14/22) had pleocytosis and 73% (16/22) high protein levels, and there were no significant differences between patients with and without HIV infection. CSF VDRL tests were reported as reactive in 88% (22/25) of patients. Median CSF VDRL titers were lower in HIV-infected patients (p=0.006), and a higher proportion of HIV-negative patients had CSF VDRL titers ≥1:4 (p=0.02). 72% of patients received high-dose intravenous aqueous crystalline penicillin G. Conclusions. The majority of patients with NS had HIV infection. Early NS was more common than late NS and the CSF VDRL titers were lower in HIV-infected patients. High-dose intravenous penicillin was the most frequently used therapy.