Changing patterns of late syphilis.

Abstract

Polish studies of late syphilis and neomosyphilis based mainly on cl inical case histories of the former Dermato-venereological Institute and other neurological and psychiatric clinics as well as on material from consultation clinics and going back many decades are briefly reviewed. Forms of late syphilis diagnosed in 1968 were meningovascular syphilis (32%); tabes (8%); general paresis (4%); taboparesis (1%); cardiovascula r syphilis (27%); late latent syphilis (28%). A comparison of clinical and epidemiological data for 1968 with that for 1950-1954 and 1960-1964 revealed a considerable decrease of the more serious types of syphilis and of neurosyphilis in particular. Serious cases of cardiovascular syphilis and all cases of aortic insufficiency decreased from 12.6% to 2% during the period under review. Cases of neurosyphilis with marked and irreversible neurological changes and significant physical or mental disablement decreased from 33.0% to 5.5%. Cases of proved but not disabling neurosyphilis which did not affect the patients ability to work decreased from 36.7% to 13.0%. These findings mirror those of Dowzenko and Zielinski who found that admission indexes of neurosyphilitic cases diagnosed from 1957 to 1965 were considerable lower than those from 1926 to 1937 the most significant decrease occuring in the 1960s and indicate the effectiveness of modern methods of venereal disease control. Dowzenko and Zielinski also analysed 418 male and 221 female case histories of patients suffering from neurosyphilis admitted to hospital and treated in 9 neurological and 9 psychiatric clinics 1956 to 1965. The majority in the neurological clinics were cases of tabes dorsalis (43.6%) and meningovascular syphilis (42.4%). In psychiatric clinics there was predominance of cases of general paresis (87.3%). In 62.7% of the tabetic patients the pathological process in the cerebrospinal fluid was inactive which might be explained by universal use of antibiotics for conditions other than syphilis. In meningovascular syphilis the tendency of the active process to regress was not so common. It is possible that treatment of early syphilis with penicillin might prevent the development of neurosyphilis.