Abstract

Syphilis is an endemic disease, particularly in low- and middle-income countries, with vascular involvement in large vessels (aortitis), but no clear relationship with stroke patients, except for those who presented with meningovascular neurosyphilis. To investigate the relationship between a positive history of syphilis determined by serological testing and ischemic stroke etiology, particularly small vessel disease (SVD). In total, 269 first-ever ischemic stroke patients admitted to the stroke unit were tested for syphilis. Patients with neurosyphilis were excluded. All patients were classified according to the ASCOD phenotyping as SVD - when SVD was the potential causal mechanism (S1) - or non-SVD - when SVD was uncertain (S2), unlike (S3), or not detected (S0). Syphilis was positive in 32 (12%) patients. When comparing patients with positive and negative serology, the only significant difference was SVD as the causal mechanism (S1) in patients with positive results: 9 (28%) vs. 22 (9%), p<0.01. The current study showed that the frequency of positive syphilis serological test was higher in patients with first-ever ischemic stroke and SVD as the potential causal mechanism. This finding could be related to the endothelial dysfunction occurring in syphilis.

Highlights

  • Syphilis is a sexually transmitted systemic infection recognized since the late 14th century[1,2], caused by the Treponema pallidum pallidum[3]

  • This study aimed to determine the relationship between a positive history of syphilis determined by serological testing and first-ever ischemic stroke (FEIS), exploring its association with the mechanism of cerebral ischemia, especially small vessel disease (SVD)

  • The ASCOD phenotyping analysis revealed nine (28%) patients in the syphilis group with SVD as a potential cause (S1) compared to 22 (9%) in the non-syphilis group, p=0.004

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Summary

Introduction

Syphilis is a sexually transmitted systemic infection recognized since the late 14th century[1,2], caused by the Treponema pallidum pallidum[3]. This study aimed to determine the relationship between a positive history of syphilis determined by serological testing and first-ever ischemic stroke (FEIS), exploring its association with the mechanism of cerebral ischemia, especially small vessel disease (SVD). Objective: To investigate the relationship between a positive history of syphilis determined by serological testing and ischemic stroke etiology, small vessel disease (SVD). Conclusion: The current study showed that the frequency of positive syphilis serological test was higher in patients with first-ever ischemic stroke and SVD as the potential causal mechanism. This finding could be related to the endothelial dysfunction occurring in syphilis

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