Clinical Characteristics and Outcomes of Patients with Otosyphilis and HIV Infection

Abstract

BackgroundThe increased rates of syphilis in HIV infected individuals has provided information on ocular and neurological complications, but data on cochleovestibular dysfunction is limited. Otosyphilis is a potentially reversible cause of hearing loss in HIV infected individuals.MethodsWe performed a retrospective chart review from 2007 through 2016 and identified six patients who met inclusion criteria of a diagnosis of otosyphilis and HIV infection. We collected the following data: demographics, clinical characteristics, laboratory findings, treatment courses, and outcomes.ResultsWe identified a total of six patients with HIV and otosyphilis. All patients were male with a mean age of 36 (range 23–51) without known predisposing factors for hearing loss. The mean CD4 count was 323 (range 17–547) with all but two patients having a viral load of less than 50 copies. Four of the patients were receiving combination antiretroviral therapy at the time of diagnosis of otosyphilis. All patients had a rapid plasma reagin (RPR) titer of at least 1:16 (range 1:16–1:128). Three patients presented with unilateral hearing loss and two with bilateral; with one patient having just vestibular dysfunction. The mean duration of symptoms prior to presentation was about seven weeks (range one week to 16 weeks). Three of six patients had objective hearing loss on audiometric testing, one had no detectable hearing loss, and two did not have formal audiometric testing. All had lumbar puncture performed at diagnosis with a CSF mean white blood cell count of 23 (range 0–129) and a mean total protein level of 38 (range 28–57). Only one patient had a positive CSF VDRL test. Five patients were treated with intravenous penicillin for 14 days and one with ceftriaxone for 14 days due to a penicillin allergy. Five patients received a corticosteroid taper. Three out of the six patients noted subjective hearing improvement with treatment in six months.ConclusionHIV infected patients with a diagnosis of syphilis should be asked screening questions to identify hearing symptoms or vestibular dysfunction, as otosyphilis is an important cause of reversible hearing loss.Disclosures All authors: No reported disclosures.