Sexually Transmitted Diseases

Skip Navigation LinksHome > May 2008 - Volume 35 - Issue 5 > Neurosyphilis in HIV-Infected Patients: Clinical Manifestati...
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Sexually Transmitted Diseases:
doi: 10.1097/OLQ.0b013e3181623853
Articles

Neurosyphilis in HIV-Infected Patients: Clinical Manifestations, Serum Venereal Disease Research Laboratory Titers, and Associated Factors to Symptomatic Neurosyphilis

Poliseli, Rodolfo MD*; Vidal, Jose E. MD, PhD†‡; Penalva De Oliveira, Augusto C. MD, PhD†§; Hernandez, Adrian V. MD, PhD∥

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Abstract

Goal: To describe clinical and laboratory features of human immunodeficiency infection (HIV)-infected patients with neurosyphilis.

Study Design: Retrospective study of 27 consecutive cases of HIV-infected patients with a positive Venereal Disease Research Laboratory (VDRL) in cerebrospinal fluid (CSF).

Results: Median of age was 36 years and 89% were men. Ten (37%) patients had previous nonneurologic syphilis treatment. At the time of neurosyphilis diagnosis, 10 (37%) patients had early syphilis, and 6 of them were neurologically asymptomatic. Nine (33%) patients had symptomatic neurosyphilis. Twenty-six (96%) patients were classified with early neurosyphilis. The medians of serum VDRL and CD4+ T cell counts were 1:128 and 182 cell/μL, respectively. Twenty five (93%) patients presented serum VDRL titers ≥1:16. Five of 6 patients with early syphilis and asymptomatic neurosyphilis, presented serum VDRL ≥1:16. Symptomatic patients showed lower CD4+ T cell counts (59 cell/μL vs. 208 cell/μL, P = 0.03) and higher protein concentration on CSF (118 mg/dL vs. 39 mg/dL, P <0.001) than asymptomatic patients.

Conclusions: Most patients had early and asymptomatic neurosyphilis, and more than one third had early syphilis. Patients with symptomatic neurosyphilis showed lower CD4+ T cell counts and higher protein concentration on CSF than those asymptomatic. Most patients had serum VDRL titers ≥1:16, regardless of syphilis stage.

© Copyright 2008 American Sexually Transmitted Diseases Association

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