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

Myositis gummosa

A. Jordan and Popova-Bloom (Derm. Zisch., Bd. 55, H. 2) as a result of their observations of 8 cases of this disease come to the following conclusions that m. g. can occur in different parts of the muscles, but more often affect m. sternocleidomastoideus, women are more likely to suffer (the authors have one man out of 8 cases), because this disease is observed in individuals with lues ignorata. M. g. is a manifestation of late syphilis. Diagnosis is fraught with great difficulties and is facilitated only by a positive R. W. The prognosis is favorable, for specific treatment quickly leads to a cure.

Клінічний випадок пізньої форми сифілісу у хворої на вульгарний пемфігус

The objective. Decrease the number of diagnostic mistakes of pemphigus vulgaris and late forms of syphilis to improve quality of life and prevent premature death in patients with pemphigus vulgaris. Raise doctors’ awareness of the use of treponemal tests to clarify the diagnosis of late forms of syphilis. Materials and methods. The case of pemphigus vulgaris determined on the basis of clinical picture, anamnesis, cytological examination results is described. A concomitant pathology was diagnosed, i.e., late syphilis due to the complex of serological tests: nontreponemal and treponemal (Venereal Disease Research Laboratory test (VDRL), Enzyme-Linked Immuno Sorbent Assay (ELISA), T. pallidum Haemagglutination Assay (TP-HA), Fluorescent Treponemal Antibody Absorption test (FTA abs), ELISA-Different). Results. At dynamic supervision and inspection of the patient on pemphigus vulgaris and late syphilis on the basis of positive treponemal tests was revealed: ELISA sums. (IgG+IgM) – positive, high-quality TP-HA «4+» – positive; semi-quantitative TP-HA 1: 8 «2+» – positive; FTA abs «3+» – positive. To verify the diagnosis, a serum sample was examined by ELISA-Different method. Conclusions. Due to a wide range of serological research and consultation of related specialists, late syphilis was diagnosed in a pemphigus vulgaris patient.

Early syphilitic lesions of the nervous system

Having collected quite a lot of material on this issue (163 cases), MP Alekseev and KL Holshmid (Porm. Med. Zh., 1925, No. 3-4) found that in equal stages of syphilis, almost all those forms of damage to the nervous system that occur in late syphilis, namely, hemiplegia (due to damage to cerebral vessels), meningo-myelitis, meningo-encephalitis, disseminated encephalitis, Brown-Sequard's paralysis, tabes, progressive paralysis and especially often meningitis (141 cases out of 163).

Diagnostic Issues of Asymptomatic Neurosyphilis in HIV-Positive Patients: A Retrospective Study

Introduction: Asymptomatic neurosyphilis (ANS) is a disease that is difficult to diagnose in people living with HIV (PLWH). The European Guidelines on the management of syphilis suggest that ANS should be suspected and thus the lumbar puncture (LP) should be performed in cases of (1) late syphilis (acquired >2 years previously), (2) CD4+ cells ≤ 350/mm3 and/or a serum Venereal Disease Research Laboratory/Rapid Plasma Reagin (VDRL/RPR) title > 1:32, (3) “serological failure” after syphilis therapy, and (4) the use of alternative treatment for syphilis. In the present study, we aimed to verify the accuracy of the guideline’s criteria for the indication of LP in the suspicion of ANS in a cohort of PLWH. Methods: This retrospective study was carried out in a cohort of PLWH referred at a single medical center of a large academic hospital in Italy. Clinical and laboratory data of patients diagnosed with late syphilis were extracted from the cohort and analyzed. The European Guidelines of syphilis were adopted for patient management. Results: Out of a cohort of 713 PLWH, only 51 (7%) had a diagnosis of late syphilis and were therefore included in the study. Thirty-one subjects (61%) met one or more diagnostic criteria to perform LP: 39% (12/31) of patients undergoing LP had a diagnosis of ANS. The accuracy of predictive criteria for ANS, suggested by the guidelines, was 62% for RPR > 1:32 and 74% for CD4+ ≤ 350 cc/µL. The simultaneous occurrence of both criteria (RPR > 1:32 plus CD4+ ≤ 350 cc/µL) achieved a diagnostic accuracy of 59%. Interestingly, only 17% of patients who underwent LP for serological failure were eventually diagnosed positive for ANS. Conclusion: Asymptomatic neurosyphilis represents a challenging, but not uncommon, diagnosis. Therefore, it requires a careful investigation. Low CD4+ cell count and RPR > 1:32 remain excellent predictors of neurosyphilis, but have become the only acceptable predictors of ANS in PLWH. “Serologic failure” should be regarded with caution as a criterion to perform LP in order to investigate possible ANS in HIV-syphilis coinfected patients asymptomatic for neurological disorders. The retrospective nature of this single-site study may represent a limit to the interpretation of the data. Thus, larger clinical studies on the topic are warranted.

Incidence and Predictors of Serological Treatment Response in Early and Late Syphilis Among People Living With HIV

Background Few studies have investigated predictors of serological response to syphilis treatment in people living with HIV (PLWH). Methods This was a retrospective, longitudinal study on PLWH who were diagnosed with and treated for syphilis who had an assessable serological response between January 2004 and June 2016. Serological treatment response (TR) was defined as a ≥4-fold decline in rapid plasma reagin (RPR) titers or a reversion to nonreactive (if RPR ≤1:4 at diagnosis) 12 months after treatment for early syphilis and 24 months after treatment for late syphilis. Factors associated with a TR were assessed with multivariate Cox proportional hazard models for recurrent events. Results A total of 829 episodes of syphilis (686 early, 143 late) in 564 patients were recorded. TR was observed in 732 (88%) syphilis episodes. The proportion of TR differed between early and late syphilis (89% vs 83%, respectively; P = .045). For early syphilis, TR was associated with a higher nadir CD4+ cell count (adjusted hazard ratio [AHR], 1.06; P = .029), an RPR titer >1:32 at diagnosis (AHR, 1.26; P = .009), secondary syphilis (AHR, 1.29; P = .008), and cases of syphilis diagnosed in more recent calendar years (AHR, 1.36; P < .0001). In late syphilis, TR was more likely to occur for first infections (AHR, 1.80; P = .027), for episodes that occurred in more recent years (AHR, 1.62; P = .007), and for RPR titers >1:32 at diagnosis (AHR, 2.04; P = .002). TR was not associated with the type of treatment regimen in early and late syphilis. Conclusions Higher RPR titers at diagnosis and a diagnosis of syphilis that was made in more recent years were associated with TR in early and late syphilis.