Article Text

other Versions

PDF
Neurosyphilis in patients with HIV
  1. Emily Hobbs1,
  2. Jaime H Vera1,2,
  3. Michael Marks3,
  4. Andrew William Barritt1,4,
  5. Basil H Ridha1,4,
  6. David Lawrence2,3
  1. 1Brighton and Sussex Medical School, University of Sussex, Brighton, UK
  2. 2Lawson Unit, Royal Sussex County Hospital, Brighton, UK
  3. 3Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
  4. 4Hurstwood Park Neurological Centre, Haywards Heath, UK
  1. Correspondence to Dr David Lawrence, Lawson Unit, Royal Sussex County Hospital, Brighton BN2 5BE, UK; David.S.Lawrence{at}lshtm.ac.uk

Abstract

Syphilis is a resurgent sexually transmitted infection in the UK that is disproportionately diagnosed in patients living with HIV, particularly in men who have sex with men. Syphilis appears to present differently in patients with HIV, particularly in those with severe immunosuppression. Progression to neurosyphilis is more common in HIV coinfection and can be asymptomatic, often for several years. The presentations of neurosyphilis vary but can include meningitis, meningovascular disease, general paresis and tabes dorsalis. There is debate about the circumstances in which to perform a lumbar puncture, and the current gold standard diagnostics have inadequate sensitivity. We recommend a pragmatic approach to lumbar punctures, interpreting investigations and deciding when to consider treatment with a neuropenetrative antibiotic regimen.

  • neurosyphilis
  • syphilis
  • HIV

Statistics from Altmetric.com

Footnotes

  • Contributors EH and DL conducted the literature search and appraised the evidence. EH and DL prepared the manuscript. MM, AWB, BHR and JHV reviewed the manuscript and provided specialist input.

  • Funding None declared.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Provenance and peer review Provenance and peer review. Commissioned. Externally peer reviewed. This paper was reviewed by Nicholas Davies, London, UK.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.