WP 204 Complicated Syphilis May be More Common Than Previous Estimates Suggest

Tuesday, June 10, 2014
International Ballroom
Julia C. Dombrowski, MD, MPH, Department of Medicine (Infectious Diseases), University of Washington and Public Health - Seattle & King County HIV/STD Program, Seattle, WA, Rolf Pedersen, DIS, Public Health - Seattle & King County HIV/STD Program, Seattle, WA, Christina M. Marra, MD, Departments of Neurology and Medicine (Adjunct), University of Washington, Seattle, WA, Roxanne P. Kerani, PhD, Department of Medicine (Infectious Diseases), University of Washington, Seattle, WA and Matthew R. Golden, MD, MPH, Department of Medicine, Division of Allergy and Infectious Disease, and Public Health - Seattle & King County HIV/STD Program, University of Washington, Seattle, WA

Background:  Symptomatic neurosyphilis is considered to be a rare complication of syphilis, (1.2-1.7% of cases), but to our knowledge, no contemporary studies have sought to actively identify symptoms of neurologic, otologic or ocular complications in a population-based sample. 

Methods:  Our program has asked all persons with syphilis about symptoms of complicated infections (changes in vision, hearing or tinnitus) as part of routine case investigations since 2/2012.  Disease intervention specialists (DIS) query patients about symptoms using a standardized protocol and interview form.  To determine the prevalence of symptoms, we reviewed cases reported from 3/1/2012 - 9/30/2013 that met one of the following criteria (mutually exclusive and hierarchical as listed): 1) neurosyphilis reported by the diagnosing provider, 2) partner services record indicating neurologic symptoms, 3) treatment with a regimen effective for neurosyphilis, or 4) a record of cerebrospinal fluid (CSF) testing. We assumed that remaining cases had no symptoms of complicated syphilis. We separately analyzed a strict definition of symptomatic neurosyphilis, including only symptomatic cases with documented abnormal CSF results.

Results:  A total of 573 syphilis cases were reported; 68 (11.9%) met review criteria [by criterion listed in Methods as follows: 1) N=33; 2) N=20; 3) N=4; 4) N=11].  We excluded from the symptom prevalence calculation 1 case of congenital syphilis and 3 cases for which we could not obtain symptom data.  Of the 569 remaining cases, 46 (8.1%) were associated with symptoms suggesting complicated syphilis.  Most commonly reported were vision changes (5.1%), followed by hearing changes (3.9%), tinnitus (2.7%), and other symptoms (0.7%).  The distribution of symptoms was similar when we restricted the analysis to symptoms ascertained by diagnosing providers.  Using the strict definition, 18 of 573 (3.1%) had symptomatic neurosyphilis.

Conclusions:  Our results suggest that symptomatic neurosyphilis and symptoms suggestive of complicated syphilis are more common than previously estimated.