The findings and conclusions in these presentations have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.

Thursday, May 11, 2006 - 9:00 AM
373

Consequence of the Syphilis Epidemic Among Men Who Have Sex with Men (MSM):Neurosyphilis in Los Angeles, 2001-2004

Melanie M. Taylor1, Getahun Aynalem2, Leanne Olea2, He Peter2, Hawkins Kellie2, Smith Lisa2, and Kerndt Peter2. (1) DSTSP, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-02, Atlanta, GA, USA, (2) STD Program, Los Angeles County Dept of Health Services, 2615 South Grand Ave, Suite 500, Los Angeles, CA, USA


Background:
Neurosyphilis is a serious condition that may result in permanent neurologic sequelae.

Objective:
To describe the demographics, clinical manifestations, and HIV status of persons diagnosed with neurosyphilis (NS) during the MSM syphilis epidemic.

Method:
Syphilis cases reported to the health department were reviewed for diagnosis of NS, CSF VDRL results and/or treatment for NS. Medical chart reviews were performed to collect data on confirmed and probable cases of NS.

Result:
During 2001-2004, 2,799 cases of early syphilis were diagnosed in Los Angeles. Of these, 1,817 (65%) occurred in MSM. One hundred cases of confirmed or probable NS were identified during this period. Seventy-nine (79%) of these had neurological signs or symptoms of NS. Forty-four percent (N = 35) of symptomatic cases were White, 33% (N = 26) were Hispanic, and 23% (N = 18) were African-American. Thirty-five (44%) of the symptomatic cases occurred during secondary (N = 23) or early latent (N = 12) syphilis. Sixty percent (N = 47) of the symptomatic cases were HIV-positive (18% on HAART, median CD4 count 306, median viral load 48,147 copies/ml near the time of diagnosis); 52% (N = 41) occurred among MSM. The median viral load near the time of diagnosis was significantly higher among symptomatic NS cases as compared to asymptomatic cases (p = 0.02). The most common presenting symptoms were headache (42%, N = 33), visual changes (42%, N = 33), and altered mental status (23%, N = 18). Thirty percent (N = 24) of symptomatic cases had residual symptoms 3 months after treatment.

Conclusion:
Persons at risk for acquiring syphilis should be counseled regarding the risk of developing neurologic deficits due to neurosyphilis.

Implications:
Public health departments in areas of high syphilis morbidity among MSM should consider the need for heightened surveillance for this manifestation of syphilis.