1359. Reported Neurologic, Ocular, and Otic Manifestations among Syphilis Cases — 16 States, 2019

Background Syphilis can cause neurologic, ocular, or otic manifestations at any stage, possibly resulting in permanent disability or even death. In 2018, CDC began collecting clinical manifestation data for syphilis cases reported through the National Notifiable Diseases Surveillance System (NNDSS). We present the first estimates of the prevalence of neurologic, ocular, and otic manifestations among syphilis cases in the United States. Methods We reviewed NNDSS data to identify jurisdictions (states + DC) who reported ≥ 70% of their syphilis cases with clinical manifestation data (considered to have “complete reporting”) in 2019. Among these jurisdictions, we determined the prevalence of neurologic, ocular, and otic manifestations (combining verified, likely, and possible clinical manifestations together), stratified by HIV status and by syphilis stage (Unknown/late syphilis vs. Early syphilis [Primary, Secondary, and Early non primary non secondary syphilis]). Results In 2019, 16 states had complete reporting for neurologic, otic, and ocular manifestations. Of the 41,216 syphilis cases reported in these jurisdictions, clinical manifestations were infrequently reported: neurologic (n=445, 1.1%), ocular (n=461, 1.1%), and otic (n=166, 0.4%). Prevalence was higher among HIV-infected persons compared to HIV-negative persons for neurologic (1.4% vs. 0.9%) and ocular manifestations (1.3% vs 1.0%) but was similar for otic manifestations (0.4% vs 0.4%). Prevalence was higher among persons diagnosed with Unknown/late syphilis compared to Early syphilis for neurologic (1.6% vs 0.8%) and ocular manifestations (1.6% vs 0.9%) but similar for otic manifestations (0.5% vs 0.4%); however, 49.4% of cases reported with ≥ 1 of these clinical manifestations were diagnosed with Early syphilis. Conclusion The prevalence of neurologic, ocular, and otic manifestations was low among syphilis cases, but case data likely underestimate the true burden given potential underreporting. The frequency of clinical manifestations, including among HIV-negative persons and persons diagnosed with Early syphilis, emphasizes the importance of evaluating all syphilis cases for clinical signs or symptoms regardless of stage or HIV status. Disclosures All Authors: No reported disclosures

How much penicillin is needed to treat early syphilis in people living with HIV?

A clinical decision report using: Andrade R, Rodriguez-Barradas MC, Yasukawa K, Villarreal E, Ross M, Serpa JA. Single Dose Versus 3 Doses of Intramuscular Benzathine Penicillin for Early Syphilis in HIV: A Randomized Clinical Trial. Clin Infect Dis. 2017;64(6):759-764. https://doi.org/10.1093/cid/ciw862 to inform treatment of syphilis for a person living with HIV with multiple socioeconomic barriers to care.

An uncommon presentation of a common disease: a case of tertiary syphilis

Thoracic aortic aneurysm is one of the late and uncommon presentations of syphilis. If the aneurysm is large it causes symptoms suggesting mass effect. Syphilis being a common disease worldwide has recently re-emerged. Early syphilis if left untreated can lead to a significant morbidity. We reported a case of 44 years old man who was incidentally detected to have syphilitic thoracic aortic aneurysm with features of SVC compression.