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Abstract Details

Screening For Neurosyphilis Among Adults with Syphilis In Zambia
Infectious Disease
P5 - Poster Session 5 (8:00 AM-9:00 AM)
10-006
To evaluate the utility of a neurosyphilis screening tool (NST) amongst adults in Zambia who were newly diagnosed with Syphilis.
Syphilis is common in Zambia, affecting 7% of adults, and often occurs with HIV co-infection which confers a higher risk of neurosyphilis. However, neurosyphilis screening is not commonly undertaken at the time of syphilis diagnosis.
We enrolled consecutive adults who tested positive for syphilis at two sexually transmitted infection clinics in Zambia. Participants completed a demographic questionnaire and underwent a medical evaluation by a non-specialist doctor, including NST consisting of ten symptom questions and 12 neurological examination maneuvers. Participants endorsing ≥ 1 symptom or with any exam abnormality were offered lumber puncture(LP) for evaluation of neurosyphilis and then followed three-monthly for one year. We present a descriptive analysis of the cohort. 

We enrolled 262 participants, of which 47% (n=123) were male with average age 34±11 years. Ninety-eight (37%) had HIV co-infection (81% on antiretroviral therapy; median[IQR] CD4 count: 505 [331,663] cells/ul) and 27% (n=71%) reported prior syphilis infection syphilis infection. Twenty-nine (11%) screened positive and were older (44±12 vs 32±10, p<0.001) and more likely to have a prior syphilis infection (62% vs 23%, p<0.001) than those who screened negative. More participant who screened positive also had HIV (52% vs 36%), though this was not significant (p=0.09). Only half of those who screened positive accepted LP, and CSF VDRL was negative in all cases. However, 15 (52%) of those who screened positive were treated for neurosyphilis. Of 4 participants who screened positive and failed treatment at one year, three were not treated for neurosyphilis.
Symptoms and signs of neurosyphilis were common in this cohort of Zambian adults with syphilis, but limited LP acceptance and laboratory reliability limited evaluation of the accuracy of the NST.
Authors/Disclosures
Ndonji Chiwaya, MD
PRESENTER 		Ndonji Chiwaya has nothing to disclose.
Mashina Chomba, MBChB (University of Zambia) Dr. Chomba has nothing to disclose.
Sarah Braun, MD (University Teaching Hospital, Lusaka, Zambia) Sarah Braun has nothing to disclose.
Deanna Saylor, MD, MHS (Johns Hopkins Hospital) Dr. Saylor has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for 好色先生. The institution of Dr. Saylor has received research support from National Institutes of Health. The institution of Dr. Saylor has received research support from 好色先生. Dr. Saylor has a non-compensated relationship as a Member of multiple committees and task forces focused on improving access to MS medications to people across the world with Multiple Sclerosis International Federation that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the Neurology and COVID19 committee with World Health Organization that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the International Outreach Committee, Junior and Early Career Membership Committee, and 好色先生al Innovation Commitees with American Neurological Association that is relevant to AAN interests or activities.