Patients with late syphilis and neurosyphilis treated in Bialystok in 2014-2023.

Abstract

Background: Late syphilis (LS) is rarely reported stage of the infection with Treponema pallidum. It develops after one year of untreated infection and most frequently is asymptomatis. Central nervous system (CNS) can be involved in any stage of syphilis. Neurosyphilis (NS) can be asymptomatic or manifest as meningitis, meningovascular syphilis, parenchymatous syphilis, CNS gummas, ocular or auricular syphilis.

Objective: To evaluate patients with LS and NS hospitalized at the Department of Dermatology and Venereology and treated at Outpatient Clinic of Medical University of Bialystok in years 2014-2023.

Material and methods: A retrospective analysis of socio-demographic, epidemiological and clinical data, treatment of patients with LS and NS and, in part, their serological response after treatment.

Results: Over a ten-year period 25 patients were treated for LS: 14 men and 11 women. The mean age in men was 39.3 and in women - 38.4 years (P>0.05). Majority of patients lived in urban areas and was in a steady partnership. Five men (35.7%) declared homosexual intercourses. Symptomatic LS was diagnosed only in one men. The median titre of a VDRL test was 1/16. After treatment follow up was completed in nine (36.0%) patients. In four of them (44.4%) no decline in VDRL titre was noticed one year after treatment. In the same period eight patients were treated for NS, confirmed by a cerebro-spinal fluid (CSF) examination. Only one of them had asymptomatic NS, remaining ones had neurological or ophthalmic abnormalities. In seven (87.5%) the VDRL test titre was at least 1/64. Half of men with NS were co-infected with HIV prior to diagnosis of NS.

Conclusions: The study results confirm that LS is asymptomatic in majority of cases. Adherence to after-treatment follow-up remains suboptimal. The results suggest that in patients with high titre of serological tests for syphilis and concomitant HIV infection examination of CSF might be needed.