Results of therapy of latent and asymptomatic syphilis in a prison population: I. Clinical outcome with reference to cardiovascular and central nervous system syphilis and related to a nonsyphilitic control population

Abstract

1. 1. A report is given of the long-term results of therapy of latent syphilis with “adequate” arsenobismuth therapy in terms of clinical and serologic response. 2. 2. The prison milieu of treatment made possible close and careful serologic and clinical follow-up. Thus, a 10 per cent sample was given complete posttreatment examination at a time averaging about 14 years after treatment. 3. 3. To provide a control group against which to assess the significance of the so-called abnormal neurologic findings, reflex and pupillary examinations were performed by the same physicians, utilizing identical examination techniques, on a group of 847 nonsyphilitic prisoners in the same institution. 4. 4. The minimum rate of progression to neurosyphilis in the group “adequately” treated for latency was 0.3 per cent. 5. 5. The proportion of patients in the sample showing clinical evidence of possible neurosyphilis or cardiovascular syphilis was small. Of 255 for whom complete records are available, out of the final 277 examined, only 36 showed any tendon reflex abnormalities, and only 19 showed pupillary abnormalities of any kind. In none of these patients could a diagnosis of neurosyphilis be made unequivocally, and it appears that the abnormalities reported are of the same order as found in a nonsyphilitic group of comparable status. 6. 6. In this same group, only 11 findings in 10 patients suggestive of cardiovascular syphilis were found; and, of these, only one with aortic aneurysm had evidence permitting an unequivocal diagnosis of cardiovascular syphilis. 7. 7. “Adequate” arsenotherapy, given according to the standards utilized at Sing Sing prison for treatment of latent syphilis, results in a high degree of success in prevention of the development of neurosyphilis or cardiovascular syphilis.