Clinical and laboratory characteristics of patients with symptomatic neurosyphilis before and after intensive anti-syphilis treatment

Abstract

Objective To analyze the clinical characterisitcs and laboratory indexes of patients with symptomatic neurosyphilis before and after intensive anti-syphilis therapy, and its significance for curative effect evaluation. Methods Data of 29 patients with HIV-negative symptomatic neurosyphilis in Beijing Ditan Hospital, Capital Medical University were analyzed, retrospectively. Serum and cerebrospinal fluid (CSF) were detected by toluidine red unheated serum test (TRUST) and treponema pallidum particle agglutination test (TPPA) before treatment and 6 months after treatment. The levels of serum TRUST (serum-TRUST), white blood cell count in CSF (CSF-WBC) (× 106/L), cerebrospinal fluid protein level in CSF (CSF-PRO) (mg/dl) and dynamic changes of CSF-TRUST were detected, respectively. The clinical significance and evaluation value of curative effect of the above indicators were analyzed. Results There were 8 cases (27.58%) with serum-TRUST decreased more than 4 times after 6 months intensive anti-syphilis treatment, which were 15 cases (51.72%) 2 years after treatment. Before treatment, 6 months after treatment and 2 years after treatment, the median (quartile) of log2serum-TRUST countdown were 1.81 (1.20, 2.11), 1.51 (1.20, 1.81) and 1.20 (0.90, 1.51), respectively, the differences between every two groups were significant (all P < 0.001). There were 17 patients (62.97%) with CSF-TRUST titers decreased more than 4 times or negative at the end of 6 months after treatment. Before treatment and 6 months after treatment, the median (quartile) of log2serum-TRUST countdown were 0.60 (0.30, 0.90) and 0.30 (0.00, 0.60), respectively, with significant difference (Z = -3.012, P = 0.003). Before treatment and 6 months after treatment, the median (quartile) of CSF-PRO were 64.50 (52.05, 88.55) and 50.85 (37.28, 65.25), respectively, with significant difference (Z =-3.238, P = 0.001). Conclusions Titers of CSF-PRO and CSF-TRUST before and after treatment could be used to evaluate the curative effect of patients with neurosyphilis, and the decrease of serum-TRUST titer ≥ 4 times could predict the curative effect of patients with neurosyphilis. Key words: Symptomatic neurosyphilis; Intensive anti-syphilis therapy; Clinical and laboratory characteristics