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Spinal Cord Ser Cases 2020 Jun 30;6(1):56. Epub 2020 Jun 30.

Department of Neurosurgery, University Hospital Center Mohammed VI, Faculty of Medicine, Mohammed First University, Oujda, Morocco.

Introduction: Neurosyphilis is a sexually transmitted disease secondary to the invasion of the central nervous system by the Treponema pallidum. The spinal syphilitic gumma is rare.

Case Presentation: We report a case of extradural cervical spinal syphilitic gumma revealed by spinal cord compression in a 58-year-old male. Read More

Front Neurol 2020 5;11:496. Epub 2020 Jun 5.

Division of Neurodegenerative Disorders, St Boniface Hospital Research, University of Manitoba, Winnipeg, MB, Canada.

Dementia is an umbrella term-caused by a large number of specific diagnoses, including several neurodegenerative disorders. Alzheimer's disease (AD) is now the most common cause of dementia in advanced countries, while dementia due to neurosyphilis was the leading cause a century ago. Many challenges remain for diagnosing dementia definitively. Read More

Clin Infect Dis 2020 Jun;71(Supplement_1):S13-S20

Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

We conducted a systematic review of relevant syphilis diagnostic literature to address the question, "What is the sensitivity and specificity of the treponemal tests currently approved by the Food and Drug Administration (FDA) for the diagnosis of syphilis (by stage)?" There were 16 treponemal assays evaluated: 13 immunoassays and 3 manual assays (fluorescent treponemal antibody absorbed test [FTA-ABS], microhemagglutination assay for Treponema pallidum antibodies [MHA-TP], Treponema pallidum particle agglutination assay [TP-PA]). MHA-TP and FTA-ABS were less sensitive in primary and secondary syphilis than TP-PA; TP-PA is the most specific manual treponemal assay. There is insufficient evidence to recommend one particular treponemal immunoassay (eg, enzyme immunoassays, chemiluminescence immunoassays, microbead immunoassays) over another based on published performance data. Read More

Clin Infect Dis 2020 Jun;71(Supplement_1):S21-S42

Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

We reviewed the relevant syphilis diagnostic literature to address the following question: what are the performance characteristics, stratified by the stage of syphilis, for nontreponemal serologic tests? The database search included key terms related to syphilis and nontreponemal tests from 1960-2017, and for data related to the venereal disease research laboratory test from 1940-1960. Based on this review, we report the sensitivity and specificity for each stage of syphilis (primary, secondary, early latent, late latent, or unknown duration; tertiary as well as neurosyphilis, ocular syphilis, and otic syphilis). We also report on reactive nontreponemal tests in conditions other than syphilis, false negatives, and automated nontreponemal tests. Read More

Cerebrovasc Dis 2020 Jun 22:1-6. Epub 2020 Jun 22.

Neurology and Stroke Unit Service, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil.

Background And Aims: Syphilis and stroke are high prevalent diseases in south Brazil and estimates of concomitance and possible role of syphilis in acute stroke are lacking. Our aims are to estimate the prevalence of syphilis and neurosyphilis (NS) in a cohort of tertiary stroke center.

Methods: We reviewed all hospital records of stroke/transitory ischemic attack (TIA) using International Classification of Diseases, 10th revision, at discharge, frequency of syphilis screen, serology positivity, cerebrospinal fluid (CSF) analysis, and prevalence of NS in this stroke population applying CDC criteria. Read More

IDCases 2020 25;21:e00840. Epub 2020 May 25.

Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.

A healthy 47-year-old immunocompetent man from Northern Canada presented for ophthalmologic assessment after experiencing one month of right-sided photopsias, floaters, and a right lower nasal quadrant visual field defect. Optic disc swelling, vitritis, chorioretinitis, peripheral retinal infiltrates and hemorrhages were noted in the right eye. A broad right inferior arcuate and nasal visual field defect were also present. Read More

Sex Transm Dis 2020 Jun 2. Epub 2020 Jun 2.

A 23-year-old HIV-positive woman presented with persistent yellowish verrucous plaques on both ankles, which had been present for for two years, and blurred vision, which had persisted for one month. Serological tests confirmed a syphilis diagnosis. Her condition improved after systemic penicillin treatment, with no topical treatment except petrolatum ointment. Read More

Expert Rev Anti Infect Ther 2020 Jun 1:1-11. Epub 2020 Jun 1.

Department of Neurology, University Hospital, Ludwig Maximilian University , Munich, Germany.

Introduction: Central nervous system (CNS) infections can be life-threatening and are often associated with disabling sequelae. One important factor in most CNS infections is a timely pathogen-specific treatment. The diagnostic methods available, however, do not always reach a satisfying sensitivity and specificity. Read More

Vestn Otorinolaringol 2020 ;85(2):73-77

Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Academician Preobrazhensky Department of Otorhinolaryngology, Moscow, Russia.

The epidemiology of neurosyphilis is presented in article. The pathogenetic mechanisms of involvement in the syphilitic process are described already in the early stages of the disease of the central and peripheral nervous system and, in particular, of the auditory and vestibular analyzers. Described classical clinical forms of neurosyphilis. Read More

Med J Malaysia 2020 May;75(3):199-203

University of Malaya, Department of Medicine, Department of Medical Microbiology, Kuala Lumpur, Malaysia.

Introduction: There are limited studies on the epidemiology of syphilis in Malaysia. In this study we describe the clinical features and treatment outcomes of patients with syphilis attending a tertiary referral university hospital.

Methods: We retrospectively reviewed the case records of patients with positive serology findings for syphilis in University Malaya Medical Center (UMMC) from January 2010 to December 2015. Read More

J Dermatol 2020 May 22. Epub 2020 May 22.

Departments of, Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.

Eur Neurol 2020 May 20:1-4. Epub 2020 May 20.

Department of Neurology, Federal University of Paraná, Curitiba, Brazil.

Few authors in the Western literature have acquired such a monumental reputation as Thomas Mann and Fyodor Dostoyevsky; although with different backgrounds and aesthetic peculiarities, their writings converge thematically in their frequent relationship with disease. From Dostoyevsky's struggle with epilepsy to Mann's descriptions of tuberculosis and cholera, many are the examples found in their body of work describing medical afflictions. One noteworthy similarity in their works is the presence of hallucinations with Mephistopheles-like devilish entities, possibly caused by neurological diseases: in Mann's case, concerning the main character of Doctor Faustus, caused by neurosyphilis, while for Dostoyevsky, concerning one of the titular Brothers Karamazov, by delirium tremens. Read More

J Clin Lab Anal 2020 May 17:e23366. Epub 2020 May 17.

Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.

Background: Monocytes are recruited into the cerebrospinal fluid (CSF) of patients with neurosyphilis, suggesting abnormal chemokine expression. We aimed to investigate the aberrant expression of chemokines in the CSF of these patients.

Methods: CSF and serum samples were collected from patients with neurosyphilis between July 2017 and June 2019 in the Dermatology Department, Second Affiliated Hospital of Zhejiang University. Read More

Neurol India 2020 Mar-Apr;68(2):487-488

Department of Neurology, NEIGRIHMS, North Eastern Indira Gandhi Regional Institute of Medical Sciences Shillong, Meghalaya, India (An Autonomous Institute, Ministry of Health and Family Welfare, Government of India), India.

The manifestations of CNS syphilis are unfamiliar to a differential of patients with dementia to many physicians today as of the relative rarity of this condition. This is a classical case report of a patient with syphilis and dementia in a 55-year-old female. General paresis of insane is a progressive disease of the brain leading to mental and physical worsening. Read More

Sex Transm Infect 2020 May 4. Epub 2020 May 4.

Genitourinary Medicine and HIV, Imperial College Healthcare NHS Trust, London, UK

Sex Transm Infect 2020 May 4. Epub 2020 May 4.

Dermatologic Clinic, Ospedale Policlinico San Martino Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia, Genova, Liguria, Italy.

Spinal Cord Ser Cases 2019 05 1;5(1):38. Epub 2019 May 1.

Neurology Department, University Hospital Mohamed VI Marrakesh, Marrakesh, Morocco.

Study Design: Retrospective case series.

Objectives: To describe the epidemiological, clinical, MRI and therapeutic features and the outcomes of patients with syphilitic myelitis in a third-level hospital in Marrakesh in southern Morocco.

Setting: The Neurology Department, University Hospital Mohamed VI Marrakesh, Morocco. Read More

Radiol Bras 2020 Mar-Apr;53(2):129-136

Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo (HUCAM/UFES), Vitória, ES, Brazil.

Various neuropathologies produce hyperintense signals on T2-weighted or fluid-attenuated inversion recovery sequences of the temporal lobes. Recognition of the distribution pattern and associated findings may narrow the spectrum of differential diagnoses or suggest a specific disease. This pictorial essay aims to illustrate the relatively common diseases that affect the temporal lobe, such as herpes simplex encephalitis, neurosyphilis, limbic encephalitis, postictal edema, neoplasia, and multiple sclerosis, as well as those that are less common, such as myotonic dystrophy type 1, CADASIL, and CARASIL, together with the particularities of each entity. Read More

Mol Biol Rep 2020 May 24;47(5):3407-3421. Epub 2020 Apr 24.

Department of Dermatology and Venereology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.

Syphilis is a chronic sexually transmitted disease caused by infection with Treponema pallidum, which can invade various system organs, leading to clinical manifestations such as neurosyphilis, ocular syphilis, and cardiovascular syphilis and seriously endangering human health. Serofast status is a common outcome after syphilis treatment that presents an important clinical problem. At present, the etiology of serofast status remains unknown. Read More

Int J Mol Sci 2020 Apr 22;21(8). Epub 2020 Apr 22.

Department of Biochemical Diagnostics, Medical University of Bialystok, 15-269 Bialystok, Poland.

Neuroborreliosis (NB) and neurosyphilis (NS) are abnormal conditions caused by spirochetal bacteria which affect the nervous system. Diagnosis of neuroborreliosis and neurosyphilis is determined by clinical examination of visible symptoms, serum and cerebrospinal fluid (CSF) analysis, and serological detection of antibodies against and respectively. Establishing a diagnosis may sometimes pose a number of diagnostic difficulties. Read More

Stereotact Funct Neurosurg 2020 22;98(3):150-159. Epub 2020 Apr 22.

Department of Clinical Neuroscience, Umeå University, Umeå, Sweden,

During the 20th century, only two persons have been awarded the Nobel Prize for psychiatric discoveries, Julius Wagner-Jauregg in 1927 for the introduction of malaria inoculation in dementia paralytica and Egas Moniz in 1949 for prefrontal leucotomy. According to traditional narrative, Moniz was inspired by a presentation by Carlyle Jacobsen on prefrontal lesions in chimpanzees at a congress in London in 1935. A few months later, he performed the first operations with the help of a young neurosurgeon. Read More

Zh Nevrol Psikhiatr Im S S Korsakova 2020 ;120(2):98-102

St. Petersburg University 199034, St. Petersburg, Russia.

A clinical case of late neurosyphilis with prominent cognitive function failure developed in a young male patient is presented. Atypical disease development and negative laboratory tests required to perform the differential diagnosis with inflammatory and degenerative brain diseases, extended blood and CSF tests for syphilis. During the diagnostic procedures the patient received complex therapy with neurotropic, antioxidant, and anti-dementia drugs. Read More

PLoS Negl Trop Dis 2020 04 6;14(4):e0007921. Epub 2020 Apr 6.

Department of Laboratory Medicine, University of Washington, Seattle, Washington, United States of America.

Developing a vaccine against Treponema pallidum subspecies pallidum, the causative agent of syphilis, remains a public health priority. Syphilis vaccine design efforts have been complicated by lack of an in vitro T. pallidum culture system, prolific antigenic variation in outer membrane protein TprK, and lack of functional annotation for nearly half of the genes. Read More

Br J Ophthalmol 2020 Mar 27. Epub 2020 Mar 27.

Department of Ophthalmology, Tygerberg Hospital, Cape Town, South Africa.

Background/aims: In the era of increasing incidence of syphilis globally, ocular syphilis is re-emerging as an important cause of uveitis. The aim of this study was to determine the clinical and laboratory characteristics of ocular- and neurosyphilis among individuals with and without HIV infection.

Methods: Retrospective analysis of patients diagnosed with ocular syphilis presenting to Tygerberg Hospital, South Africa, over a 5-year period ending December 2018. Read More

Cureus 2020 Feb 14;12(2):e6998. Epub 2020 Feb 14.

Internal Medicine, Upstate Medical University, Syracuse, USA.

In the pre-antibiotic era, neurosyphilis (NS) was common, occurring in 34% of patients with syphilis. Currently, there has been a rising trend in syphilis with HIV-infected patients being more prone to develop NS. Ocular involvement is very rare in NS and accounts for only 1%-5% of the cases in the United States. Read More

Rev Soc Bras Med Trop 2020;53:e20190546. Epub 2020 Mar 16.

Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Radiologia, Campinas, SP, Brasil.

Int J Med Microbiol 2020 Apr 9;310(3):151416. Epub 2020 Mar 9.

Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College & National Center for STD Control, China Centers for Disease Control and Prevention, 210042, Nanjing, China. Electronic address:

Endothelium damage caused by Treponema pallidum is the key step in the systemic dissemination and pathophysiology of syphilis, particularly cardiovascular syphilis and neurosyphilis. However, the molecular mechanisms supporting endothelium damage of syphilis are undefined. The outer membrane proteins were thought to be involved. Read More

Pituitary 2020 Jun;23(3):253-257

Department of Neurosurgery, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People's Republic of China.

Purpose: Multi-syphilitic gummas in pituitary and cerebellopontine angle (CPA) are extremely rare and easily misdiagnosed especially in patients with antibiotic abuse. We write this paper for clinicians to better understanding of cerebral gumma.

Methods: We report a patient with syphilitic gummas in pituitary and left CPA. Read More

Dermatol Ther (Heidelb) 2020 Apr 2;10(2):273-283. Epub 2020 Mar 2.

Jinling Hospital Department of Dermatology, Nanjing Medical University, Nanjing, 210002, People's Republic of China.

Introduction: Many studies have explored the imaging characteristics of patients with neurosyphilis, but no systematic study has been made on the neuroimaging changes after anti-syphilitic treatment. The purpose of this study was to examine neuroimaging differences before and after treatment, comparing patients with asymptomatic and symptomatic neurosyphilis.

Methods: A total of 102 patients with neurosyphilis, including 60 cases of symptomatic neurosyphilis and 42 cases of asymptomatic neurosyphilis, were identified between December 2012 and June 2019. Read More

Front Neurol 2020 5;11:62. Epub 2020 Feb 5.

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

To explore cerebrospinal fluid (CSF) levels of soluble triggering receptor expressed on myeloid cells 2 (sTREM2) and neurofilament light proteins (NFL) in patients with neurosyphilis (NS). We enrolled 71 NS patients (41 early-NS and 30 late-NS patients) and 20 syphilis but non-NS patients whose CSF samples were collected. The CSF levels of the microglial activation biomarker sTREM2 and neuronal injury biomarker NFL were measured using ELISA. Read More

Enferm Infecc Microbiol Clin 2020 Jan;38 Suppl 1:7-11

Grupo de Microbiología Translacional, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA); Grupo de Estudio de Infecciones de Transmisión Sexual. GEITS, SEIMC; Servicio de Microbiología, Hospital Universitario Central de Asturias, Oviedo, España; Área de Microbiología, Facultad de Medicina, Universidad de Oviedo, España; Instituto Universitario Fernández Vega (IUFV) y Fundación de Investigación Oftalmológica (FIO), Oviedo, España. Electronic address:

Syphilis is a sexually transmitted infection caused by Treponema pallidum subsp. pallidum with an increasing incidence in Spain and in the rest of the world. Diagnosis is based mainly on serology, since direct diagnosis by dark field microscopy presents difficulties that limit its widespread use. Read More

Clin Infect Dis 2020 Feb 26. Epub 2020 Feb 26.

Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Background: Neurosyphilis, a complication of syphilis, can occur at any stage of infection. Measuring the prevalence of neurosyphilis is challenging and there are limited data on the prevalence of neurologic or ocular symptoms among patients with syphilis. We sought to describe the prevalence of neurologic and/or ocular symptoms among early syphilis (ES) cases and the clinical management of symptomatic cases enrolled in the STD Surveillance Network (SSuN) Neuro/Ocular Syphilis Surveillance project. Read More

N Engl J Med 2020 02;382(9):845-854

From the Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore (K.G.G.); and the Department of Medicine and Division of Infectious Diseases and Immunology, University of Massachusetts Medical Center, Worcester (S.R., P.A.R.).

Clin Pract Cases Emerg Med 2020 Feb 19;4(1):46-50. Epub 2019 Nov 19.

Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.

Recent epidemiologic data demonstrate increasing rates of neurosyphilis, particularly among those in the community of men who have sex with men and those coinfected with the human immunodeficiency virus (HIV). Here we discuss a case of early neurosyphilis and new HIV diagnosis in a 27-year-old previously-healthy trans woman presenting for the second time with progressive, ascending weakness and cranial nerve VI palsy. Emergency physicians should consider this rare but highly morbid diagnosis, given the rising prevalence of neurosyphilis among at-risk patients and those with new neurologic deficits. Read More

Sex Transm Infect 2020 Feb 7. Epub 2020 Feb 7.

Department of Medicine, Johns Hopkins University, Baltimore, MD 21224, USA

Front Neurol 2019 15;10:1352. Epub 2020 Jan 15.

Department of Radiology, Weihai Central Hospital, Weihai, China.

Neurosyphilis, which is caused by , is a rare sexually transmitted disease involving the central nervous system (CNS). Among all the sub-categories, spinal syphilitic gumma is extremely rare. In previous literature, limited cases of spinal syphilitic gumma have been reported, most of which underwent surgery treatment. Read More

Sex Transm Infect 2020 Jan 20. Epub 2020 Jan 20.

Genitourinary Medicine and HIV, Imperial College Healthcare NHS Trust, London, UK.

Rheumatology (Oxford) 2020 Jan 18. Epub 2020 Jan 18.

Rheumatology Department, La Paz University Hospital, Madrid, Spain.

Objectives: To describe the frequency and causes for the presence of a halo sign on the ultrasound of patients without a diagnosis of GCA.

Methods: In total, 305 patients with temporal artery colour Doppler ultrasound showing the presence of halo sign (intima-media thickness ≥0.34 mm for temporal arteries [TAs] and ≥1 mm for axillary arteries) were included, and their medical records were reviewed. Read More

Cardiovasc Pathol 2020 May - Jun;46:107175. Epub 2019 Oct 28.

Department of Cardiac Surgery, Baylor University Medical Center, Dallas, TX, USA.

Aortic syphilis today is infrequently diagnosed clinically. Described herein are findings in 5 women who had resection of a fusiform aneurysm of the tubular portion of ascending aorta, and examination of the wall of the aneurysm disclosed classic features of aortic syphilis. The 5 patients were among 36 who had ascending aortic operations at Baylor University Medical Center in Dallas in 2018 and early 2019. Read More

Parkinsonism Relat Disord 2020 Jan 8. Epub 2020 Jan 8.

Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India.

Ocul Immunol Inflamm 2020 Jan 16:1-7. Epub 2020 Jan 16.

Virology, University Medical Center Utrecht, Utrecht, Netherlands.

: To evaluate immunoblot (IB) and polymerase chain reaction (PCR) to diagnose ocular- and neurosyphilis.: Prospective cross-sectional study. Aqueous humor (AH) and cerebrospinal fluid (CSF) samples were tested for treponemal DNA or antibodies to treponemal antigens. Read More

Clin Med (Lond) 2020 Jan;20(1):95-97

Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia.

Neurosyphilis is a broad term used to describe an infection caused by in the central nervous system. While this was a common cause of stroke in the 19th century, it saw a decline after the introduction of penicillin. However, in the recent past, there has been an increase in the incidence of syphilis, especially with HIV coinfection. Read More

Cureus 2019 Dec 10;11(12):e6337. Epub 2019 Dec 10.

Pharmacy, Lake Erie College of Osteopathic Medicine (LECOM), Bradenton, USA.

We present a case of a patient with tertiary syphilis, manifesting as acute psychosis, auditory hallucinations and intermittent explosive disorder with pending legal ramifications for physical violence. Our patient had been seen and treated by a psychologist with Aripiprazole for his erratic and aggressive behavior coupled with his new found psychosis over a one-year period with no avail. Prior accounts of interaction with the patient described him as "easy going", "laid back", and cooperative. Read More

Parkinsonism Relat Disord 2020 Jan 7. Epub 2020 Jan 7.

Centre for Brain Health, Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland; Ireland East Hospital Group, Dublin, Ireland; Health Affairs, University College Dublin, Dublin, Ireland. Electronic address: http://www.neurologicalinstitute.ie.

Rom J Ophthalmol 2019 Oct-Dec;63(4):406-411

Ophthalmology Department, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania.

We present a case of a 47-year-old female patient, with papillitis in the right eye and anterior uveitis in both eyes, as a manifestation of untreated neurosyphilis. Read More

Tijdschr Psychiatr 2019 ;61(10):720-724

In the last few years, an increasing worldwide incidence in syphilis has been reported, mostly in the United States and Western Europe. Neurosyphilis is characterized by a wide differential diagnosis, which too often causes the disease to remain undetected for a long time. We report a case of a male patient with manic psychotic symptoms, in whom neurosyphilis was identified after elaborate diagnostic investigations. Read More

BMJ Case Rep 2019 Dec 22;12(12). Epub 2019 Dec 22.

Ophthalmology, Sydney Eye Hospital, Sydney, New South Wales, Australia

A 39-year-old Caucasian man presented with headaches and retro-orbital pain but normal vision. Bilateral optic nerve swelling was found on funduscopy though optic nerve function and computed perimetry were normal and there was no relative afferent pupillary defect. CT venogram and MRI were unremarkable. Read More

J Infect Chemother 2020 Feb 16;26(2):296-299. Epub 2019 Dec 16.

Department of Neurology, Beijing Ditan Hospital, Capital Medical University, No. 8 East Jing Shun Rd, Chaoyang District, Beijing, 100015, China. Electronic address:

Syphilitic myelitis is an extremely rare manifestation of neurosyphilis and often misdiagnosed. However, a small amount of literature describe its clinical manifestations and neuroimaging features, and there is no relevant data on the prognosis, especially the long follow-up prognosis. In this paper, four syphilitic myelitis patients admitted to our hospital between July 2012 and July 2017 were retrospectively reviewed. Read More

N Engl J Med 2019 12;381(24):2377