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.