Abstract Details

Title Clinical Presentation Differences in "Confirmed" and "Presumptive" Neurosyphilis

Topic Infections/AIDS/Prion Disease

Presentation(s) S16 - (-)

Poster/Presentation
Number 006

Objective

Background Syphilis has seen a surge in incidence in United States since beginning of last decade. CDC provides case definition for "confirmed" and "presumptive" neurosyphilis, with the former being any syphilis stage with positive CSF-Venereal Disease Research Laboratory (VDRL) and later being any stage of syphilis with negative CSF-VDRL, elevated CSF protein or WBC and clinical symptoms consistent with neurosyphilis. There is a dearth of large population based epidemiological studies on neurosyphilis is post-antibiotic, HIV era. We tried to characterize and compare clinical presentations of "confirmed" and "presumptive" neurosyphilis in tertiary care hospital.

Design/Methods This study is a retrospective chart review. After IRB approval, all inpatient and outpatient medical records from 01/01/2001 to 12/31/2011 with a diagnosis of neurosyphilis were reviewed. Patients were divided into 2 groups based on CSF-VDRL positive or negative status. Clinical symptoms of the patients were reviewed from medical records and compared between the two groups using descriptive statistical tools.

Results A total of 178 patients with diagnosis of neurosyphilis were treated during the study period. 46 patients, with average age of 45.2 years were "confirmed" neurosyphilis. 132 patients, with average age of 47.3 years had "presumptive" neurosyphilis diagnoses. Most commonly seen presentation included seizures (12.1% compared to 13%), optic neuritis (4.5% vs 4.3%), stroke (10.6 vs 6.5)/hemiplegia (10.6% vs 13.0%), affect disorder (6.8% vs 8.6%), and dementia 9% vs 8.6%). None of the clinical presentations were significantly different between two sub groups.

Conclusions The clinical presentation of patients diagnosed with neurosyphilis, whether "confirmed" or "presumptive" do not differ in clinical presentation. The CDC diagnostic criteria of "presumptive" diagnosis of neurosyphilis seem to be clinically reliable as diagnostic tool.

Authors/Disclosures
PRESENTER	No disclosure on file
Vineet Punia, MD (Cleveland Clinic)	Dr. Punia has nothing to disclose.
Jayant N. Acharya, MD, DM, FAAN (Southern Illinois University School of Medicine)	Dr. Acharya has nothing to disclose.

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