Neurosyphilis

Czech version

Authors: D. Vaňousová ¹; R. Černý ²; H. Zákoucká ³; P. Kožner ⁴; D. Jilich ⁵; J. Lisý ⁶; J. Hercogová ¹; L. Machala ⁷
Authors‘ workplace: Dermatovenerologická klinika 2. LF UK a Nemocnice Na Bulovce, Praha ¹; Neurologická klinika dospělých 2. LF UK a FN v Motole, Praha ²; Národní referenční laboratoř pro syfilis, Státní zdravotní ústav, Praha ³; Oční oddělení, Nemocnice Na Bulovce, Praha ⁴; Klinika infekčních a tropických nemocí 1. LF UK a Nemocnice Na Bulovce, Praha ⁵; Klinika zobrazovacích metod 2. LF UK a FN v Motole, Praha ⁶; Klinika infekčních nemocí 3. LF UK a Nemocnice Na Bulovce, Praha ⁷
Published in: Cesk Slov Neurol N 2012; 75/108(3): 297-302
Category: Review Article

Overview

Syphilis is an old disease and its incidence in developed countries decreased in the second half of the last century. However, at present, syphilis is on increase again. Since 1990, when the incidence was lowest, the incidence of syphilis in the Czech Republic increased more than six-fold with HIV+ homosexual men and drug addicts being the highest risk groups. The CNS can be involved at any stage of syphilis; early forms of neurosyphilis currently predominate, whereas late complications rarely occur. The diagnosis of syphilis is based on serological tests. A combination of both nonspecific (nontreponemal) and specific (treponemal) methods are used for screening; specific tests are used for confirmation. Clinical symptomatology of neurosyphilis is very variable and comprehensive analysis of cerebrospinal fluid including specific and nonspecific serologic tests plays a crucial role in diagnostics. Legislation requires all cases of diagnosed syphilis to be reported and treated. Neurosyphilis is treated with benzylpenicillin as a standard, other antibiotics are less effective. After completing the therapy, all patients are followed up long-term by a venereologist. Considering the complex clinical and laboratory symptomatology of neurosyphilis, correct diagnosis and optimal therapeutic decision requires close cooperation between a neurologist, venereologist and laboratory specialist.

Key words:
syphilis – neurosyphilis – diagnosis – therapy

Sources

1. Hercogova J, Vanousova D. Syphilis and borreliosis during pregnancy. Dermatol Ther 2008; 21(3): 205–209.

2. Global prevalence and incidence of selected curable sexually transmitted infections. Geneva: WHO 2001.

3. The World Health Report 2004 – Changing history. Geneva: WHO 2004.

4. Centers for Disease Control and Prevention (CDC). Primary and secondary syphilis – United States, 2003–2004. MMWR Morb Mortal Wkly Rep 2006; 55(10): 269–273.

5. Uuskula A, Puur A, Toompere K, DeHovitz J. Trends in the epidemiology of bacterial sexually transmitted infections in eastern Europe, 1995–2005. Sex Transm Infect 2010; 86(1): 6–14.

6. Coyne KM, Banks A, Heggie C, Scott CJ, Grover D, Evans C et al. Sexual health of adults working in pornographic films. Int J STD AIDS 2009; 20(7): 508–509.

7. Savage EJ, Hughes G, Ison C, Lowndes CM. Syphilis and gonorrhoea in men who have sex with men: a European overview. Euro Surveill 2009; 14(47): Dostupné z URL: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19417.

8. Pohlavní nemoci 2009. Praha: Ústav zdravotnických informací a statistiky ČR 2010: Dostupné z URL: http://www.uzis.cz/publikace/pohlavni-nemoci-2009.

9. Rozehnalová Z, Hercogová J, Jilich D, Machala, Rozsypal H. Koinfekce syfilis a HIV. Čes-slov Derm 2009; 84(5): 278–283.

10. Zákoucká H, Polánecký V, Kaštánková V. Syphilis and gonorrhoea in the Czech Republic. Eurosurveillance 2004; 9(12): Dostupné z URL: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=496.

11. Peeling RW, Hook EW jr. The pathogenesis of syphilis: the Great Mimicker, revisited. J Pathol 2006; 208(2): 224–232.

12. Tantalo LC, Lukehart SA, Marra CM. Treponema pallidum strain-specific differences in neuroinvasion and clinical phenotype in a rabbit model. J Infect Dis 2005; 191(1): 75–80.

13. Lukehart SA, Hook EW jr, Baker-Zander SA, Collier AC, Critchlow CW, Handsfield HH. Invasion of the central nervous system by Treponema pallidum: implications for diagnosis and treatment. Ann Intern Med 1988; 109(11): 855–862.

14. Marra CM, Castro CD, Kuller L, Dukes AC, Centurion-Lara A, Morton WR et al. Mechanisms of clearance of Treponema pallidum from the CSF in a nonhuman primate model. Neurology 1998; 51(4): 957–961.

15. Funnyé A, Akhtar A. Syphilis and human immunodeficiency virus co-infection. J Natl Med Assoc 2003; 95(5): 363–382.

16. Doutlík S. Infekce a nervová soustava. Praha: Avicenum 1987.

17. Golden M, Marra C, Holmes K. Update on syphilis: resurgence of an old problem. JAMA 2003; 290(11): 1510–1514.

18. Lukesova J, Triskova J. Dnešní problematika syfilis a neurosyfilis v psychiatrii. Česk Psychiatr 1982; 78(5): 326–331.

19. Hook EW, 3rd, Marra CM. Acquired syphilis in adults. N Engl J Med 1992; 326(16): 1060–1069.

20. Soares-Fernandes JP, Ribeiro M, Mare R, Magalhaes Z, Lourenco E, Rocha JF. Diffusion-weighted magnetic resonance imaging findings in a patient with cerebral syphilitic gumma. J Comput Assist Tomogr 2007; 31(4): 592–594.

21. Prokosch V, Thanos S. Emerging syphilitic optic neuropathy: critical review and recommendations. Restor Neurol Neurosci 2008; 26(4–5): 279–289.

22. Rothenberg R, Becker G, Wiet R. Syphilitic hearing loss. South Med J 1979; 72(2): 118–120.

23. Zákoucká H. Syfilis – tradiční choroba, současný problém II. Zprávy CEM (SZÚ, Praha) 2007; 16(10–11): 493–497.

24. Larsen S, Johnson R. Diagnostic Tests. In: Larsen S, Pope W, Johnson R (eds). Manual of Tests for Syphilis. Washington: American Public Health Association Publications 1999: 1–52.

25. Norris S, Weinstock GM. Comparative genomics. In: Radolf J, Lukehart S (eds). Pathogenic Treponema: Molecular And Cellular Biology. Wymondham: Caister Academic Press 2006: 19–38.

26. Jirouš J, Knappová M, Hercogova J. Možnosti zkřížené reakce v sérologii syfilidy a lymeské borreliózy. Čes-slov Derm 1991; 66(3): 183–188.

27. Woznicova V, Smajs D, Wechsler D, Matejkova P, Flasarova M. Detection of Treponema pallidum subsp. pallidum from skin lesions, serum, and cerebrospinal fluid in an infant with congenital syphilis after clindamycin treatment of the mother during pregnancy. J Clin Microbiol 2007; 45(2): 659–661.

28. Flasarova M, Smajs D, Matejkova P, Woznicova V, Heroldova-Dvorakova M, Votava M. Molekulární detekce a typizace Treponema pallidum subsp. pallidum v klinickém materiálu. Epidemiol Mikrobiol Imunol 2006; 55(3): 105–111.

29. Marra C, Tantalo L, Maxwell C, Dougherty K, Wood B. Alternative cerebrospinal tests to diagnose neurosyphilis in HIV-infected individuals. Neurology 2004; 63(1): 85–88.

30. Timmermans M, Carr J. Neurosyphilis in the modern era. J Neurol Neurosurg Psychiatry 2004; 75(12): 1727–1730.

31. Woznicová V. Neurosyfilis. Prakt Lék 2006; 86(12): 698–702.

32. Reiber H, Peter JB. Cerebrospinal fluid analysis: disease-related data patterns and evaluation programs. J Neurol Sci 2001; 184(2): 101–122.

33. Alam F, Yasutomi H, Fukuda H, Horiguchi J, Murakami Y, Ohshita T et al. Diffuse cerebral white matter T2-weighted hyperintensity: a new finding of general paresis. Acta Radiol 2006; 47(6): 609–611.

34. Branger J, van der Meer JT, van Ketel RJ, Jurriaans S, Prins JM. High incidence of asymptomatic syphilis in HIV-infected MSM justifies routine screening. Sex Transm Dis 2009; 36(2): 84–85.

35. O‘Donnell JA, Emery CL. Neurosyphilis: A Current Review. Curr Infect Dis Rep 2005; 7(4): 277–284.

36. Resl V. Doporučené postupy pro praktické lékaře. Sexuálně přenosné nemoci II. Praha 2002: MZ ČR a ČLS JEP.

37. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR 2010; 59(RR12): 1–110.

38. French P, Gomberg M, Janier M, Schmidt B, van Voorst Vader P, Young H. IUSTI: 2008 European Guidelines on the Management of Syphilis. Int J STD AIDS 2009; 20(5): 300–9.

39. Crowe G, Theodore C, Forster GE, Goh BT. Acceptability and compliance with daily injections of procaine penicillin in the outpatient treatment of syphilis-treponemal infection. Sex Transm Dis 1997; 24(3): 127–130.

40. Jorgensen J, Tikjob G, Weismann K. Neurosyphilis after treatment of latent syphilis with benzathine penicillin. Genitourin Med 1986; 62(2): 129–131.

41. Marinella MA. Jarisch-Herxheimer reaction. West J Med 1996; 165(3): 161–2.

42. Robinson JL, Hameed T, Carr S. Practical aspects of choosing an antibiotic for patients with a reported allergy to an antibiotic. Clin Infect Dis 2002; 35(1): 26–31.

43. Matejková P, Flasarová M, Zákoucká H, Borek M, Kremenová S, Arenberger P et al. Macrolide treatment failure in a case of secondary syphilis: a novel A2059G mutation in the 23S rRNA gene of Treponema pallidum subsp. pallidum. J Med Microbiol 2009; 58(6): 832–836.

44. Marra CM, Maxwell CL, Tantalo LC, Sahi SK, Lukehart SA. Normalization of serum rapid plasma reagin titer predicts normalization of cerebrospinal fluid and clinical abnormalities after treatment of neurosyphilis. Clin Infect Dis 2008; 47(7): 893–899.