Positive Syphilis Serology Research Articles

P208 In an era of antibmicrobial stewardship is epidemiological treatment for syphilis still justified?

IntroductionThe BASHH guidelines for syphilis recommend the offer of epidemiological treatment or re-screening at 12 weeks (12w) after exposure for asymptomatic sexual contacts. We reviewed local practice and compliance with...

Improving the antenatal and post-partum management of women presenting to Sexual Health Services with positive syphilis serology through audit.

The incidence of congenital syphilis remains low in the UK, but the morbidity and mortality to babies born to women who are untreated for the condition make testing for the disease antenatally one of the most cost-effective screening programmes. Women attending North Middlesex Hospital, UK with a positive syphilis test at their antenatal booking visit are referred to St Ann's Sexual Health Clinic, London, for management and contact tracing. We were concerned that our initial audit revealed that a large proportion of women referred to our service never attended and recorded partner notification was poor. Following the implementation of recommendations, specifically the introduction of an electronic referral system, re-audit showed an improvement in attendance, contact tracing, documentation and communication.

Evaluation of the management of pregnancies and infants at risk for congenital syphilis: La Réunion, 2008 to 2014

To evaluate the maternal-fetal management and follow-up of infants at risk for congenital syphilis. Monocentric retrospective cohort study at the Félix Guyon Hospital, Saint-Denis, La Réunion between January 2008 and December 2014. Management of 38 pregnancies (35 women, 39 fetuses) with a positive syphilis serology was evaluated according to the Centers for Disease Control and Prevention (CDC) guidelines. A total of 68% (n=26) of pregnancies were screened before 16 weeks of gestation, and 26% (n=10) had appropriate treatment. Adverse outcomes were noted in 45% of pregnancies. Neonatal serology was not performed in 7 live-born neonates (19%) and 33 infants were classifiable according to the four CDC scenarios. In the infants, adequate complementary evaluation and appropriate treatment were noted in 42% (n=13) and 55% (n=17) of cases, respectively. Rate of infant follow-up was 76% (n=16). No treatment failure was observed in infants. Reinforcement of public health policies and a better sensitization, training and collaboration among perinatal caregivers are warranted given the gaps revealed in our study.

Serological follow-up of infants born to mothers with positive syphilis serology - real-world experiences.

The 2008 UK syphilis guideline recommends infants born to women with any positive syphilis serology be followed up until both treponemal and nontreponemal tests are negative to exclude congenital syphilis, whereas Centers for Disease Control and Prevention guidelines recommend using only nontreponemal tests. Historically, we had low infant follow-up rates with no coherent pathways. We initiated a change in multidisciplinary team practice of infant testing for syphilis in 2011 and evaluated the results before and after by retrospective review of testing of infants born to women with positive syphilis serology between 2005 and 2012. A total of 28 infants' mothers were treated in pregnancy (termed 'high risk'); 26 had adequate treatment prior to pregnancy (termed 'low risk'). There was a significant increase in serological testing after 2011 compared with before (83% versus 48%; OR 5.07 [95% CI 1.22-22.77] p = 0.01) but mainly in low risk infants with no significant improvement in high risk infants who are the priority group. Using nontreponemal tests only in the infants would have reduced the tests required by at least 50%, allowing health resources to be concentrated on achieving adequate follow-up for those infants most at risk.

Epidemiological Profile of Newly Diagnosed HIV-Infected Patients in Northern Paris: A Retrospective Study.

In attempt to identify the factors associated with delayed diagnosis during HIV infection, we studied retrospectively the epidemiological profile of HIV-infected patients diagnosed between January 1, 2012 and December 31, 2013 and followed in our clinical center in Paris. Data were compared to those obtained at the same site during the year 2003. One hundred eighty-six patients fulfilled the inclusion criteria: 49 (26%) had a CD4 count <200/mm3 at diagnosis. Compared to subjects with CD4 count ≥200/mm3, advanced patients were older, had a higher plasma viral load, had more often an AIDS-defining event at the time of HIV diagnosis (45% vs. 3%), had been infected more often through heterosexual contact (69% vs. 44%), had less frequently past HIV testing (23% vs. 63%), and tended to live in less favorable conditions. A higher proportion of these patients initiated antiretroviral therapy in the 3 months following diagnosis (93.9% vs. 48.1%). Compared to data obtained in 161 patients in 2003, the proportions of advanced patients were similar between the two periods (26% vs. 22%). There was a significant increase from year 2003 to the 2012-2013 period in the proportion of men who have sex with men (MSM) (50% vs. 27%) and in the percentage of patients infected with HIV-1 subtype B (48% vs. 27%) and with positive syphilis serology (22% vs. 8%). Our data show that (1) HIV screening should be extended to populations with the following characteristics: older age, heterosexuality, and low socioeconomic level, and (2) HIV transmission continues to progress in MSM, arguing for the value of preexposure prophylaxis.

Secondary syphilis in HIV positive individuals: correlation with histopathologic findings, CD4 counts, and quantity of treponemes in microscopic sections.

Although syphilis is uncommon, infection rates are much higher in HIV-infected individuals than the general population. A proposed explanation is impaired cellular immunity with HIV infection. A search of one institution yielded 10 patients with a diagnosis of secondary syphilis on skin biopsy, positive syphilis serology and available CD4 counts. We evaluated 11 biopsies from the 10 patients. We correlated the patients' CD4 counts with the histologic findings and with the number of treponemes on skin biopsies, highlighted by immunohistochemistry (IHC). We also compared the detection of spirochetes in silver stained sections (e.g. Warthin-Starry) with T. pallidum IHC. All biopsies were assessed for various histologic features. The sensitivity of IHC to detect treponemes was 64% and of silver stain was 9% (p-value 0.04). The number of treponemes on the biopsies was determined by IHC. High numbers of spirochetes (i.e. >100 per 10 hpf) were only seen in patients with CD4 counts less than 250 cells/ml. The most consistent histologic finding was a moderate to severe lymphoplasmacytic infiltrate. Although the study is small, it appears that a higher number of spirochetes is associated with CD4 counts less than 250 cell/ml. The T. pallidum IHC stain was vastly superior to the Warthin-Starry stain.

Adverse pregnancy outcomes following syphilis treatment in pregnancy in the UK.

Syphilis infection in pregnancy is known to cause a number of severe adverse pregnancy outcomes, including second-trimester miscarriage, stillbirth, very pre-term delivery and neonatal death, in addition to congenital syphilis. A retrospective review of women with positive syphilis serology and a pregnancy outcome between 2005 and 2012 in Leeds, UK, was performed. In all, 57 cases of positive syphilis serology in pregnancy were identified: 24 with untreated syphilis treated in the current pregnancy (Group 1); seven with reported but unconfirmed prior treatment who were retreated (Group 2); and 26 adequately treated prior to pregnancy (Group 3). The rate of severe adverse pregnancy outcomes in Group 1 at 21% was significantly higher than the 0% outcome of Group 3 (p = 0.02). The severe adverse pregnancy outcomes were two second-trimester miscarriages, two pre-term births at 25 and 28 weeks and one stillbirth at 32 weeks. There were no cases of term congenital syphilis or term neonatal death, but we observed high rates of other adverse pregnancy outcomes despite treatment during pregnancy. Rapid referral for treatment is needed before 18 weeks in order to minimise adverse pregnancy outcomes.

Screening for Syphilis During Pregnancy in Turkey

OBJECTIVE: To assess the prevalence of syphilis among patients at a tertiary referral center in Turkey and determine the need for antenatal syphilis screening based on the results. STUDY DESIGN: A retrospective cohort study based on patient data obtained from a tertiary referral center in Turkey. Serological syphilis screening using the Venereal Disease Research Laboratory (VDRL) was performed on all pregnant women as a part of routine antenatal care at their first hospital visit during pregnancy. Treponema pallidum hemagglutination assay (TPHA) was used to confirm positive screening results for syphilis. RESULTS: Patients’ mean age was 27.4 years. The incidence of positive syphilis serology was 0.013% (one patient), which was supported by a positive confirmatory test (0.013%).The TPHA-positive pregnant woman diagnosed with syphilis was treated with benzathine penicillin, and she gave birth to normal infants without any signs of congenital syphilis. CONCLUSION: Syphilis prevalence should be determined in each developing country with population-based studies. According to the prevalence of syphilis, each country should determine its own syphilis antenatal screening policies.

P233 A Case of CMV (Cancer Mimicking Virulence)

Background/introduction Generalised lymphadenopathy and fatigue have a broad differential diagnosis ranging from curable infections to lymphoma. Certain diagnoses can be delayed or missed altogether when patients do not present to sexual health clinics. Aim(s)/objectives Highlight secondary syphilis as a cause of lymphadenopathy amongst non-sexual health colleagues. Expand syphilis testing beyond sexual health clinics, even in the absence of classical risk factors. Methods Case report of secondary syphilis which was misdiagnosed despite numerous investigations in primary and secondary care. Results A 23 year Caucasian lady was referred to lymphoma clinic by her GP with a three month history of lymphadenopathy and fatigue. She was diagnosed with a primary CMV infection and lost to follow up after her symptoms resolved. One year later she attempted to donate blood. Positive syphilis serology with a low RPR was detected on routine blood screening by the transfusion service. The patient was referred to Bristol Sexual Health Centre where sexual history taking revealed she had a bi sexual partner at the time of her illness who also tested positive for syphilis. An archived blood sample from the time of her illness revealed active syphilis infection with a high RPR. Discussion/conclusion Secondary syphilis can mimic numerous illnesses. However syphilis testing remains uncommon outside of sexual health clinics for a variety of reasons. A change of culture is required to ensure medical professionals are prepared for routine sexual enquiry and consider syphilis as a potential cause for lymphadenopathy.

The Significance of Isolated Reactive Treponemal Enzyme Immunoassay in the Diagnosis of Early Syphilis.

The Treponemal test algorithm for syphilis screening is widely used. A diagnostic challenge between identifying early syphilis versus a false positive signal occurs in cases where the treponemal enzyme immunoassay (EIA) is reactive and confirmatory T. pallidum particle agglutination assay is negative. We investigated the diagnostic outcome of isolated reactive EIA in patients attending a sexual health clinic. Results of syphilis serology tests carried out at Birmingham Whittall Street Clinic between August 10, 2010, and November 31, 2014, were reviewed. Cases with isolated EIA were routinely invited for repeat syphilis serology. Outcomes of patients with isolated EIA were reviewed and the proportion with confirmed positive syphilis serology on their repeat test identified. The number of isolated EIA cases needed to retest to identify 1 case of early syphilis was calculated. A total of 121,724 syphilis screening tests were performed. Among the 1561 individual patients with reactive EIA sera, 316 (20% of total reactive tests) had isolated reactive EIA. Repeat syphilis serology results of 163 patients were reviewed; 106 patients remained with isolated reactive EIA, 50 had negative EIA test and 7 (4.3%) had confirmed reactive EIA. Of the 7 patients, 2 had evidence of early syphilis infection. The number of isolated EIA needed to retest to identify 1 case of early syphilis was 81.5 (95% confidence interval, 22.9-671.4). Routine recall of patients with isolated EIA sera is not warranted. Risk of acquisition or presence of early syphilis should be assessed independently and irrespective of a negative syphilis screening test or isolated EIA.

Declining Inconsistent Condom Use but Increasing HIV and Syphilis Prevalence Among Older Male Clients of Female Sex Workers: Analysis From Sentinel Surveillance Sites (2010-2015), Guangxi, China.

Clients of female sex workers (CFSWs) are a bridge population for the spread of HIV and syphilis to low or average risk heterosexuals. Most studies have examined the point prevalence of these infections in CFSWs. Limited evidence suggests that older age CFSWs are at a higher risk of acquiring sexually transmitted diseases compared with younger clients. Thus, we sought to describe long-term trends in HIV, syphilis, and hepatitis C (HCV) to better understand how these infections differ by sex worker classification and client age. We also examined trends in HIV, syphilis, and HCV among categories of female sex workers (FSWs).We conducted serial cross-sectional studies from 2010 to 2015 in Guangxi autonomous region, China. We collected demographic and behavior variables. FSWs and their clients were tested for HIV, syphilis, and HCV antibodies. Positive HIV and syphilis serologies were confirmed by Western blot and rapid plasma regain, respectively. Clients were categorized as middle age (40–49 years) and older clients (≥50 years). FSWs were categorized as high-tier, middle-tier, or low-tier based on the payment amount charged for sex and their work venue. Chi-square test for trends was used for testing changes in prevalence over time.By 2015, low-tier FSWs (LTFSWs) accounted for almost half of all FSWs; and they had the highest HIV prevalence at 1.4%. HIV prevalence declined significantly for FSWs (high-tier FSW, P = 0.003; middle-tier FSWs; P = 0.021; LTFSWs, P < 0.001). Syphilis infections significantly declined for FSWs (P < 0.001) but only to 7.3% for LTFSWs. HCV and intravenous drug use were uncommon in FSWs. HIV prevalence increased for older age clients (1.3%–2.0%, P = 0.159) while syphilis prevalence remained stable. HCV infections were halved among older clients in 3 years (1.7%–0.8%, P < 0.001). Condom use during the last sexual encounter increased for FSWs and CFSWs. Few clients reported sex with men or intravenous drug use. Clients preferred LTFSWs, especially older clients (81.9%).Our results suggest that HIV and syphilis infections are increasing in older clients who prefer LTFSWs. HIV and syphilis are likely increasing in Guangxi Province through heterosexual transmission.

The Distribution of Syphilis Among Inpatients in Wenzhou, China: A Hospital Based Study.

BackgroundThe high prevalence of syphilis among inpatients is an important concern in clinical settings. Thus, a better understanding of the serological test would be valuable.ObjectivesWe analyzed the serological test results for syphilis among the inpatients in Wenzhou central hospital, China, to estimate the distribution of syphilis this Chinese population.Patients and MethodsThe blood samples of 81946 inpatients at the hospital from January 2010 to December 2012 were collected and retrospectively analyzed. Syphilis testing was conducted using a Treponema pallidum enzyme-linked immunosorbent assay (TP-ELISA) and a TP particle agglutination (TPPA) assay. A toluidine red unheated serum test (TRUST) was then used to determine the titer of TP antibody in the TP- ELISA-positive samples.ResultsIn total, 1618 of the 81946 inpatients showed positive syphilis serology; the positive rates in 2010, 2011, and 2012 were 2.27%, 1.58%, and 2.11%, respectively. Males had a significantly higher positive rate when compared to females. Surprisingly, the highest positive rate was observed among patients older than 80 years, followed by patients younger than 19 years, while patients aged 20 - 39 years had the lowest positive rate. The TRUST titer of most TP-positive cases was less than 1:8. Patients aged 20 - 39 years showed the highest percentage of TRUST titer values ≥ 1:8, while patients older than 80 years showed the lowest percentage; the differences between these two groups were statistically significant.ConclusionsThe serological characteristics of syphilis varied with gender and age. Syphilis screening and control should be conducted for young patients and pregnant women, but special attention should also be paid to elderly inpatients. The TRUST assay is better used in syphilis screening and for judgment of curative effects, but the diagnosis needs specific methods, such as the TP-ELISA and the TPPA test.

Resultados de sorologia para casos de sífilis em campanha de município no norte do Brasil

The World Health Organization estimates that approximately 12 million new cases of syphilis occur per year in the world. The aim of this study was to evaluate results in a campaign of active search of syphilis cases in the City of Belem, Para State, Brazil, entitled no controle da sifilis (Belem in syphilis control). This campaign was aimed at the population of reproductive age, above 15 years old. Twelve Municipal Health Centers were selected based on the target audience and positive cases of Belem Health Districts. From October 24, 2013 to October 30, 2013, samples for serology were collected and 630 tests were conducted by Rapid Check Syphilis. The results of the campaign showed that the positive serology for syphilis in the sampled population was 6%, corresponding to 40 cases with positive diagnosis. The most prevalent age group was 21-40 years old in females and 31-50 years old in males. The campaign demonstrated efficacy in syphilis diagnosis, improving the principles of health promotion and disease prevention that focus on maternal and fetal mortality. It is recommended that health services participate actively in the diagnostic campaigns offered by health networks, and continually make available the rapid testing to users and treatment for positive cases.

UK national guidelines on the management of syphilis 2015.

These guidelines are an update for 2015 of the 2008 UK guidelines for the management of syphilis. The writing group have piloted the new BASHH guideline methodology, notably using the GRADE system for assessing evidence and making recommendations. We have made significant changes to the recommendations for screening infants born to mothers with positive syphilis serology and to facilitate accurate and timely communication between the teams caring for mother and baby we have developed a birth plan. Procaine penicillin is now an alternative, not preferred treatment, for all stages of syphilis except neurosyphilis, but the length of treatment for this is shortened. Other changes are summarised at the start of the guideline.

Subsequent pregnancies in women with previous gestational syphilis.

This study included data on syphilis-positive pregnant women seen for delivery or miscarriage, between 1997 and 2004, in Sao Lucas Hospital, Porto Alegre, RS. Their subsequent obstetric outcomes were studied, until December 2011, to see if the disease recurred. From 450 pregnant women with positive syphilis serology, seen from 1997 to 2004, 166 had at least one more obstetric attendance until December 2011, with 266 new obstetric outcomes. Congenital syphilis (CS) was demonstrated in 81.9% of the initial pregnancies and in 68.4% of the subsequent ones. The main causes of CS in subsequent pregnancies were a negative VDRL that turned positive at delivery, and undocumented treatment. VDRL titers were higher than 1:4 in 50.4% of the initial and 13.3% of the subsequent pregnancies (p < 0.01). Perinatal mortality rate was 119/1000 in initial and 41/1000 in subsequent pregnancies (p < 0.01). CS recurrence was frequent in subsequent pregnancies of women who tested positive for syphilis in a preceding pregnancy. No or inadequate prenatal care was the main risk factor for CS, both in initial and in subsequent pregnancies. These data suggest that non-infected neonates could have been defined as CS cases because of insufficient information about the mother's history.

HTLV-1 subtype C infection in a socially disadvantaged Indigenous Australian population: epidemiological insights from a retrospective hospital-based cohort study

The Human T-Lymphotropic Virus 1 (HTLV-1) is endemic to central Australia. No attempt has been made to control transmission among Indigenous Australians and no epidemiological studies are available that could direct any intervention. Here we report the epidemiological associations of HTLV-1 infection in a hospital cohort of socially disadvantaged Indigenous adults. Results of HTLV-1 serology were obtained from the Alice Springs Hospital (ASH) pathology database for Indigenous adults admitted 1st January 2000 to 31st December 2013. HTLV-1 proviral loads were determined for 109 asymptomatic adults. Among 1950 Indigenous adults screened, HTLV-1 western blots were positive for 621 (31.8%) and indeterminate for 51 patients (2.6%). Two of 17 (11.8%) children from western desert communities were HTLV-1 infected. Seropositivity rates increased with age and were highest for older men. In a multivariable model, increasing age, male gender, residence in the south or west and having positive syphilis serology were associated with HTLV-1 infection. Three seroconversions were recorded among 351 adults who were tested more than once during the study period. The annual incidence rate of HTLV-1 infection in this sub-group was 0.85 per 100 person-years. HTLV-1 proviral loads were <0.01 per 100 PBMC in 53 (48.6%), and exceeded 1% PBMC in 23 (19.7%) asymptomatic adults. In a hospital-based cohort of Indigenous Australians, we found childhood infections suggestive of mother-to-child transmission, document horizontal transmission and reveal an association with positive syphilis serology in a multivariable model. Cultural practices may have further amplified infection rates among older men. Multiple modes of transmission are therefore likely to contribute to high rates of HTLV-1c infection among the Indigenous population of central Australia. Most asymptomatic adults who were HTLV-1 infected appeared to have good control of HTLV-1 replication.

Syphilis serology in pregnancy: an eight-year study (2005-2012) in a large teaching maternity hospital in Dublin, Ireland.

All cases of positive syphilis serology detected in antenatal and peripartum screening in a large teaching maternity hospital in inner city Dublin, Ireland over an eight-year period (2005-2012 inclusive) were reviewed and included in our study. Demographic, antenatal registration, laboratory (including co-infections), partner serology, treatment and delivery data were recorded in our database. Infant follow-up, treatment and outcome data were also collected. During this period, 194 women had positive syphilis serology, of which 182 completed their pregnancies at the institution. This accounts for 0.28% of the total number of women completing their pregnancies during this time (N = 66038); 79 had no previous diagnosis of infection. There was one case of re-infection during pregnancy. Thirty-two women were co-infected with human immunodeficiency virus, hepatitis B or hepatitis C. There was one case suggestive of congenital syphilis infection. Our study is a comprehensive analysis of the diagnosis, management and clinical outcomes of women testing positive for syphilis infection in pregnancy. It reveals the relatively high prevalence of syphilis infection in the population utilising the maternity services in north inner-city Dublin. It re-enforces the importance of continued active surveillance to prevent morbidity and mortality associated with maternal syphilis infection. It also highlights the importance of strategies such as re-testing high-risk groups and definitive screening of spouse serology.

Syphilitic uveitis and optic neuritis in Sydney, Australia.

To describe ocular syphilis presentations to a tertiary referral eye hospital over a 5-year period and to document HIV coinfection frequency. A retrospective chart review was conducted of consecutive ocular syphilis presentations to Sydney Eye Hospital from 2007 to 2012. Inclusion criteria were positive syphilis serology, ocular inflammation on clinical examination and appropriate syphilis treatment. Outcome measures were clinical features at presentation and best-corrected visual acuity (BCVA) at interval follow-up. Thirty-seven eyes of 25 patients were included in the series. Patients were predominantly male (92.0%, p<0.05) with mean age 43.7±14.0 years. Eight (32.0%) patients had confirmed HIV coinfection, three newly diagnosed with HIV. Twelve (32.4%) eyes demonstrated anterior segment involvement with anterior uveitis. Twenty-five (67.6%) eyes demonstrated posterior segment involvement, including panuveitis, acute syphilitic posterior placoid chorioretinitis, retinitis, necrotising retinitis, punctate retinitis and optic neuritis. There was a significant improvement in BCVA for involved eyes (p<0.05) at 1 month and 2-3 months follow-up. The clinical findings of 37 eyes with ocular syphilis demonstrated a broad spectrum of clinical manifestations. Rates of HIV coinfection were high, with patients exhibiting both anterior and posterior segment inflammation. Visual outcome improved following syphilis treatment.

Seroprevalence and risk factors of syphilis among HIV/AIDS patients in Istanbul, Turkey.

Data on syphilis seroprevalence among human immunodeficiency virus (HIV)/Acquired immunodeficiency syndrome (AIDS) patients are unavailable in Turkey although they have common transmission routes. Our study is oriented towards the assessment of the seroprevalence of syphilis and the related risk factors in the HIV/AIDS patients followed in our outpatient clinic. Newly diagnosed HIV/AIDS cases (n = 308) who attended our outpatient clinic between January 2006 and April 2013 were included in the study. Patient characteristics, medical history, physical examination findings, CD4+ T lymphocyte count, HIV RNA level, rapid plasma reagent (RPR) and Treponema pallidum hemagglutination (TPHA) test results were analyzed retrospectively. TPHA positivity was considered indicative of syphilis-causing T pallidum exposure. HIV infection was transmitted through heterosexual (n = 176) or homosexual (n =131) contact (266 male, 86.3%; age 38.3 ± 11.7 years; CD4+ T lymphocyte count, 330.6 ± 15.17/mm3). 50.7% of the patients attained only primary education. Out of the 245 cases, who were asked about the number of their sexual partners, 40 patients (26 women) lived in a monogamous relationship. Condom usage was not practiced (57.2%) or was only occasional (34.4% - particularly with their legal spouses and for contraception). Physical exam revealed no signs of syphilis or other STIs. TPHA (+/- RPR) positivity was determined in 40 patients (12.9%), indicating T pallidum exposure. All patients with positive syphilis serology were male (p= 0.0026). T pallidum exposure was determined in 21.3% of homosexual and 6.8% of heterosexual cases (p = 0.0003). Since sexual contact is the most common route of transmission for both infections, syphilis seroprevalence was relatively high in our HIV/AIDS patients. Male and homosexual HIV/AIDS patients constituted a group at the highest risk for syphilis.

The Clinical Spectrum of General Paralysis of the Insane: a Historical Cohort Study.

Objectives General Paralysis of the Insane (GPI), or Dementia Paralytica, was once a fatal complication of syphilitic infection and a major reason for psychiatric hospitalisation. Syphilis re-emerged worldwide at the turn of the 20th to 21st century, and, considering the incubation period of 10-30 years, a revival of GPI may be expected within the next one or two decades. Early diagnosis and treatment improve prognosis and, therefore, a renewed clinical awareness of signs and symptoms of GPI is needed. Aims This historical cohort study aims to investigate the clinical presentation of GPI in patients deceased at the Vincent van Gogh psychiatric hospital in Venray, the Netherlands, in the period 1924-1954. Methods Annual hospital reports and individual patient's records were used for identification of patients with an established diagnosis of GPI, usually based on a combination of clinical data and positive syphilis serology. Results Individual clinical records of 105 patients (91 men; 14 women) with GPI were available for evaluation. Median age for men (50.4 years; range 31.5 to 82.1 years) was higher than for women (43.1 years; range 34.4 to 58.4 years): p = 0.01. Most patients completed elementary school only and belonged to the lower working class. Lack of judgement and insight, hyperactivity, and confusion were the most frequently documented psychiatric symptoms, whereas speech disorders, pupillary abnormalities, micturition disorders, dementia, and cranial nerve involvement were the most frequently reported neurological symptoms. Conclusions The clinical presentation of GPI displays a wide range of cognitive, affective, psychotic and focal neurological symptoms.