October 22, 2015: Neurosyphilis

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October 22, 2015


The incidence of syphilis in the United States has more than doubled from 2000 to 2013, with a recent annual rate of primary and secondary syphilis of 5.3 per 100,000.1 Populations at most risk include men who have sex with men and those with HIV co-infection. While neurosyphillis typically manifests 5-30 years after the primary infection, co-infection with HIV may expedite neurologic disease. Symptoms vary greatly, though the meningovascular form of the disease may present earliest after primary infection. This type is characterized by an obliterative endarteritis with resultant ischemic changes, and often preceded by headache, lethargy, and psychiatric symptoms.2 Neuroimaging in neurosyphilis can be normal and the diagnosis is confirmed with serologic and CSF testing, or direct visualization of the spirochete.

  1. Patton ME, Su JR, Nelson R, Weinstock H, Centers for Disease Control and Prevention. Primary and secondary syphilis-United States, 2005-2013. MMWR Morb Mortal Wkly Rep 2014; 63: 402-406.
  2. Bhai S, Lyons JL. Neurosyphilis update: Atypical is the New Typical. Curr Infect Dis Rep 2015; 17: 481.

Submitted by Adam Numis, MD, Department of Neurology, University of California, Los Angeles.

Disclosures: Dr. Numis is a member of the Resident and Fellow Section of Neurology.

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