Two cases of early neurosyphilis with ocular involvement: The need for specialist consultations in patients with early syphilis.

Abstract

Background: Syphilis is a systemic infectious disease caused by Treponema pallidum subspecies pallidum. The incidence of syphilis is increasing in Europe and, similarly, in Poland and was 9.9 cases per 100,000 inhabitants in European Union countries in 2023. The central nervous system (CNS) involvement may occur at any stage of untreated syphilis.

Objective: To demonstrate the need for specialist consultations in patients with early syphilis.

Material and methods: We present two, epidemiologically linked, HIV-negative cases of secondary syphilis with CNS and, in particular, ocular involvement.

Results: The male patient had no neurological nor ophthalmic complaints, the female noticed a slight visual acuity impairment. High titres of non-treponemal and treponemal serological tests for syphilis (STS) were noticed (VDRL 1/128, TPHA 1/20,480 and VDRL 1/64, TPHA 1/10,240 in a male and a female patient, respectively). Specialistic (neurological and ophthalmological) consultations and the examination of cerebrospinal fluid resulted in the diagnosis of neurosyphilis and administration of an appropriate treatment (with intravenous benzylpenicillin G). Six month after treatment both neurological and ophthalmological examinations' results were normal in both patients. They continue the follow-up, the titres of STS decline appropriately. Other sexual contacts of these patients were not identified and, thus, not tested.

Conclusions: Presented cases emphasise the need for multi-specialist consultations in patients with early symptomatic syphilis and high titres of STS, even in the absence of complaints or concomitant HIV infection.