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Objective: Syphilis and HIV coinfection is highly prevalent in South Africa, and both can cause neurological complications. We describe the clinical presentation and outcome of neurosyphilis in patients with and without HIV coinfection diagnosed at a tertiary facility, Groote Schuur Hospital (GSH), in South Africa., Methods: We retrospectively analyzed folders of adults with positive cerebrospinal fluid (CSF) fluorescent treponemal antibody absorption test in 2018 and 2019, with follow-up data collected until 2022., Results: HIV-coinfection was identified in 35% of the 69 included patients. Patients with HIV-coinfection were more likely to be female (58% vs 25% female, p < 0.01), and present earlier (median age = 31 years vs. 40 years, p < 0.001). Neuropsychiatric manifestations (confusion, dementia, psychosis), and strokes were the commonest clinical presentations in both groups. Those with HIV-coinfection were significantly less likely to be diagnosed with neurosyphilis by the treating clinician (71% vs. 91%, p < 0.05), as were those with a negative CSF Venereal Disease Research Laboratory (74% vs. 94%, p < 0.05). Accurate diagnosis of neurosyphilis was associated with an increased 12-month survival (alive: N = 36 [63%]) relative to those who did not receive an accurate diagnosis (alive: N = 2 [17%], p < 0.05). Those who were optimally treated with antibiotics had significantly higher 12-month survival (alive: N = 33, 63%) compared to those with suboptimal treatment (alive: N = 5, 29%), p < 0.01., Conclusion: Neurosyphilis presented similarly in those with and without HIV-coinfection. Accurate identification and optimal antibiotic treatment of neurosyphilis, particularly in CSF VDRL negative patients and those with HIV-coinfection, is necessary to improve patient survival., Competing Interests: Declaration of Competing Interest No conflicts of interest., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: There are few studies concerning the differences between asymptomatic neurosyphilis (ANS) and symptomatic neurosyphilis (SNS). This study aimed to summarize clinical, laboratory and brain Magnetic Resonance Imaging (MRI) characteristics of HIV-negative patients with ANS and SNS., Methods: Data from 43 HIV-negative patients with ANS and 59 HIV-negative patients with SNS were retrospectively collected from our hospital between December 2012 and December 2018., Results: Compared with the ANS group, SNS group had more patients that were male, age≥45 years, had brain MRI abnormalities, and exhibited higher serum/cerebrospinal fluid (CSF) TRUST titer, CSF WBC count, CSF protein concentration (P < 0.05). Multivariate regression analysis revealed that male sex, age ≥45 years and CSF TRUST titer were risk factors for SNS [odds ratio (OR) = 7.946,P = 0.001;OR = 3.757, P = 0.041; OR = 2.713, P = 0.002; respectively]. The brain MRI findings of 78 patients without comorbidities showed that ischemic infarct lesions presented in 17/37 (45.95%) of patients with ANS; infarct ischemic stroke (73.17%) especially multiple cerebral infractions (46.34%), cerebral atrophy (48.78%) were also common presentations in the SNS group., Conclusions: Patients with HIV-negative ANS and SNS presented different clinical, laboratory and brain MRI features. Male sex, age ≥45 years and elevated CSF TRUST titer may have an increased risk of developing neurological symptoms. Brain MRI abnormalities may present prior to clinical symptoms. Multiple cerebral infarctions without explained reasons or cerebral atrophy should alert clinicians the possibility of SNS., (Copyright © 2021. Published by Elsevier Ltd.)

Introduction: Syphilis is a sexually transmitted disease. All organs might be affected, but ocular syphilis only occurs in 0.6 percent of patients. We collected all cases of ocular syphilis requiring hospitalization at the University Hospital Center (UHC) in Marseille in 2017., Patients and Methods: This was a retrospective monocentric study. The diagnosis of ocular syphilis was based on the combination of ocular inflammation with a positive syphilitic serology. For each patient, sex, age, HIV status, ocular and extraocular symptoms, initial visual acuity, syphilis serology, cerebrospinal fluid (CSF) analysis if done, treatment and clinical response were collected., Results: Ten men and two women, aged 28 to 86 years, were hospitalized. Two patients were HIV-positive. Ophtalmological lesions were heterogeneous the posterior structures were most affected. Anterior uveitis was isolated in one patient. Five patients had extraocular signs with cutaneous and/or mucosal involvement. No patient had neurological symptoms. Diagnosis of neurosyphilis through CSF analysis was definite for one patient, probable for 5 patients and ruled out for 2 patients. Six patients received treatment with penicillin G and six with ceftriaxone. Visual acuity improved in all cases., Discussion: Ophtalmic cases of syphilis have become more frequent over the past few years in France. The diagnosis should be suspected in cases of eye inflammation even in the absence of favourable clinical presentation or anamnesis. Search for HIV co-infection should be systematic. Our study shows that ceftriaxone remains an effective alternative to penicillin G., (Copyright © 2019 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Human immunodeficiency virus (HIV)-infected individuals are particularly susceptible to several central nervous system infections: human cytomegalovirus, which may cause encephalitis, ventriculitis, polyradiculitis, or polyradiculomyelitis; Mycobacterium tuberculosis, which can cause meningitis or space-occupying lesions; and Treponema pallidum subspecies pallidum (T. pallidum), which affects the meninges, cerebrospinal fluid, cranial nerves, and vasculature in early neurosyphilis, and additionally the brain and spinal cord parenchyma in late neurosyphilis. Central nervous system cytomegalovirus infection is seen in HIV-infected individuals with very advanced immunosuppression. Its prognosis is poor and optimal therapy has not been determined. Tuberculous meningitis has a high mortality in those also infected with HIV, especially in the developing world, and better therapies are urgently needed. As the rates of syphilis increase in the developed world, neurosyphilis and in particular ocular syphilis are increasingly reported. The likelihood of all three of these central nervous system infections is decreased in individuals who receive potent antiretroviral therapy., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Syphilis is back since the beginning of this century. The epidemic affects mainly men having sex with men with a high proportion of HIV-infected patients. The classification of syphilis distinguishes early syphilis where patients are contagious (primary, secondary and early latent of less than one year) and late syphilis where patients are not (or less) contagious (late latent of more than one year and tertiary). The clinical presentation of syphilis has not changed. However, we must insist on the early forms of neurosyphilis, notably ophthalmic syphilis often under-diagnosed, as it affects the treatment. Serologic tests may be improved but are very helpful for the positive diagnosis and the follow-up after treatment. Treatment of early syphilis is based on one injection of benzathine benzyl penicillin G. Patients who have had syphilis must be regularly followed-up after treatment, as re-infections are common and are often asymptomatic., (Copyright © 2016 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Homosexuality is a global human phenomenon. Although the American Psychiatric Association removed homosexuality from its list of disorders more than 35years ago, homophobia among physicians is still widely prevalent. Men who have sex with men (MSM) form a relatively new epidemiological risk group for STI. To perform correct management, clinicians evaluating men with male-male sex contacts for STI related complaints or STI screening must obtain a thorough sexual history. Emerging STI like lymphogranuloma venereum, hepatitis C, and multidrug resistant N. gonorrhea strains have been described first in MSM. STI related proctitis often occur in MSM. Within the MSM population, HIV positive patients form a special group affected by STI related diseases, such as anal carcinoma and neurosyphilis. The final part of this review concludes with recommendations to reduce the STI burden in MSM., (© 2014 Elsevier Inc. All rights reserved.)

No portion of the central nervous system is immune to the ravages of syphilis. Infection by Treponema pallidum can affect the meninges, brain, brainstem, spinal cord, nerve roots, and cerebral and spinal blood vessels. As a consequence, the disease may present in diverse and, at times, diagnostically challenging fashions. Neurologic manifestations of syphilis may develop within months of the initial infection or, alternatively, take decades to appear. Although approximately one-third of individuals infected by T. pallidum display cerebrospinal fluid abnormalities suggestive of invasion of the central nervous system by the organism, only a fraction of these develop clinically significant neurologic manifestations. The features of neurosyphilis may be modified by the concomitant presence of immunosuppressive agents or conditions such as HIV/AIDS. The epidemiology of neurosyphilis has largely paralleled that of syphilis in general. A dramatic decline occurred by the early 1950s as a consequence of public health measures and the widespread use of antibiotics. The incidence had increased by the onset of the AIDS pandemic and has since corresponded with the adoption of safe sex practices. The CSF Venereal Disease Research Laboratory (VDRL) test remains the "gold standard" for diagnosis, but is not invariably positive. Penicillin remains the most effective and recommended therapy., (© 2014 Elsevier B.V. All rights reserved.)

Since the introduction of highly active antiretroviral therapy there has been an improvement in the quality of life for people with HIV infection. Despite the progress made, about 70% of HIV patients develop neurologic complications. These originate either in the central or the peripheral nervous system (Sacktor, 2002). These neurologic disorders are divided into primary and secondary disorders. The primary disorders result from the direct effects of the virus and include HIV-associated neurocognitive disorder (HAND), HIV-associated vacuolar myelopathy (VM), and distal symmetric polyneuropathy (DSP). Secondary disorders result from marked immunosuppression and include opportunistic infections and primary central nervous system lymphoma (PCNSL). A differential diagnosis which can be accomplished by detailed history, neurologic examination, and by having a good understanding of the role of HIV in various neurologic disorders will help physicians in approaching these problems. The focus of this chapter is to discuss neuropathogenesis of HIV, the various opportunistic infections, primary CNS lymphoma, neurosyphilis, CNS tuberculosis, HIV-associated peripheral neuropathies, HIV-associated neurocognitive disorder (HAND), and vacuolar myelopathy (VM). It also relies on the treatment recommendations and guidelines for the above mentioned neurologic disorders proposed by the US Centers for Disease Control and Prevention (CDC) and the Infectious Diseases Society of America., (© 2014 Elsevier B.V. All rights reserved.)

Background: Neurosyphilis is known as "the great imitator" or "the great impostor" because of its wide range of clinical symptoms. A high misdiagnosis rate of ischemic stroke was observed among neurosyphilis patients in clinical practice, which prevents patients from receiving the most appropriate treatment, and often results in more severe neurologic damage., Methods: A total of 149 neurosyphilis patients were retrospectively reviewed. The control group comprised 1570 non-neurosyphilitic ischemic stroke patients. The proportion of patients with ischemic stroke as the primary symptom of the different types of neurosyphilis and the misdiagnosis rate of neurosyphilitic ischemic stroke were analyzed, including the risk factors for cardiovascular disease., Results: Among the 149 neurosyphilis patients, 21 (14.09%) developed ischemic stroke as a primary symptom, including three cases of syphilitic meningitis and 18 cases of meningovascular neurosyphilis. Only four of the neurosyphilis patients had histories of ischemic stroke and recurrence. The other 17 cases were treated for the first time in the emergency department; however, none of the patients were initially suspected of neurosyphilitic ischemic stroke. All of the patients were only diagnosed with neurosyphilis during their follow-up treatment. The misdiagnosis rate of neurosyphilitic ischemic stroke was as high as 80.95% (17/21). Furthermore, except for hypertension, no significant differences in cardiovascular risk factors were observed between the groups (P>0.05)., Conclusions: In clinical practice, particularly during emergencies, any ischemic stroke patient should be screened for neurosyphilis., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Purpose: Neurosyphilis has protean clinical manifestations, including epilepsy. However, there is paucity of literature providing details regarding seizures. The aim of the study was to analyze the clinical profile and brain imaging features of 30 patients of neurosyphilis, and to evaluate the predictors and the outcome of seizures in this subgroup., Patient and Methods: Among the 119 patients (M:F:: 84:35) of neurosyphilis, evaluated over 6 years, 30 patients (M:W::23:7, age: 37.5+/-10.1 years, duration of illness: 11.9+/-20.1 months) were reported to have seizures. CSF-VDRL was positive in all. In addition, HIV serology was positive in 2/20., Results: Seizure was the dominant symptom in all and lone manifestation in two patients. None had history of epilepsy. Their seizure profile was: generalized (17), partial (8), and status epilepticus (5). Concomitant manifestations were encephalopathy (7), meningitis (7), dementia (6), behavioral disturbances (4), stroke (2), and optic atrophy (1). CSF study revealed pleocytosis in 24 (34.6+/-51.5/cu mm) and raised protein in 20 (67+/-33.3mg%). CT scan was abnormal in 26 patients and revealed diffuse atrophy in all and focal hypodensities in 5 patients. MRI of brain (6) showed features of ischemia (2), meningeal enhancement (1) and white matter (1) and medial temporal (2) signal changes. Three patients had reversible periodic lateralized epileptiform discharges (PLEDs), without structural lesion. Nineteen patients received penicillin and/or ceftriaxone. At a mean follow up of 6.7+/-9.4 months, 13/17 had variable improvement. Nine patients required polytherapy and seizures remained uncontrolled in five patients., Conclusions: Symptomatic seizures due to neurosyphilis are frequent, may have diverse underlying mechanism(s) and rarely can be the lone manifestation. In view of availability of specific therapy for syphilis, a high index of suspicion is recommended.