Clinical and Laboratory Characteristics of Symptomatic and Asymptomatic Neurosyphilis in HIV-Negative Patients: A Retrospective Study of 264 Cases

Wurong Li,Cheng Kou,Dongmei Xu,Meijuan Jiang,Kaiyu Qin,Lei Zhang,Wenqing Wu,Xinghu Zhang,Junhua Gao

doi:10.1155/2019/2426313

Abstract

A retrospective study was performed to compare the differences in clinical and laboratory features of asymptomatic neurosyphilis (ANS) and symptomatic neurosyphilis (SNS). A total of 264 HIV-negative inpatients with neurosyphilis were enrolled from Beijing Ditan Hospital and Beijing Tiantan Hospital between January 2014 and May 2018, including 110 SNS and 154 ANS. The SNS group had more patients in males, older median age and without antisyphilis treatment than ANS group (P<0.001, P<0.001, and P<0.001, respectively). The laboratory findings showed that the SNS group had higher pretreatment serum rapid plasma regain (RPR) titer, current serum RPR titer, cerebrospinal fluid (CSF) white blood cell (WBC) counts, CSF protein concentrations, and higher positive CSF RPR rate than those in the ANS group (P=0.011, P<0.001, P<0.001, P<0.001, and P<0.001, respectively). The multivariate logistic regression analysis revealed that male (OR=2.833, P=0.009), age≥45 years (OR=3.611, P=0.001), without antisyphilis treatment (OR=0.247, P<0.001), higher current serum RPR titer (OR=1.373, P=0.022), positive CSF RPR (OR=4.616, P<0.001), and higher CSF protein concentration (OR=1.017, P=0.026) were independent risk predictors for SNS. Therefore, clinical and laboratory features between SNS and ANS are quietly different. Male gender, age≥45 years, and lack of antisyphilis treatment are risk factors for SNS. The elevated level of serum RPR titer, CSF protein concentration, and CSF RPR titer may indicate the development of neurosyphilis and the aggravation of neurological symptoms.

Highlights

Neurosyphilis is a chronic infectious disease of central nervous system (CNS) caused by Treponema pallidum, which can occur during any stage of the syphilis and represents approximately 30% of untreated cases of the disease [1]
Several previous studies concerned with risk factors of neurosyphilis in syphilis individuals found that neurosyphilis was more prevalent in male, higher serum rapid plasma regain (RPR) titers, and HIV infection [9,10,11,12]
The risk factors associated with the development of symptomatic neurosyphilis (SNS) are still unclear

Summary

Introduction

Neurosyphilis is a chronic infectious disease of central nervous system (CNS) caused by Treponema pallidum, which can occur during any stage of the syphilis and represents approximately 30% of untreated cases of the disease [1]. Asymptomatic neurosyphilis (ANS) occurs early in CNS infection. ANS patients have serologic or clinical evidence of syphilis, or both, with CSF pleocytosis, elevated protein, reactive CSF Venereal Disease Research Laboratory (VDRL) or some combination of these abnormalities [2]. ANS patients with persistent infection or without treatment were at risk for progression to symptomatic neurosyphilis (SNS), mainly including symptomatic syphilitic meningitis, meningovascular neurosyphilis, intracranial gummas, general paresis, and tabes dorsalis [3]. Treatment of SNS patients may stop disease progression, but there will be residual stroke symptoms and signs, dementia, or sensory ataxia. We retrospectively analyzed the differences in clinical and laboratory features of 154 cases with ANS and 110 cases with SNS and explored the risk factors of SNS

Methods

Results

Discussion