Document resource
Background Neurosyphilis results from central nervous system involvement by Treponema pallidum and may occur at any stage of infection, ranging from asymptomatic cerebrospinal fluid (CSF) abnormalities to overt neurological or ocular disease. We described demographic, clinical, laboratory features of neurosyphilis cases managed at our centre.Materials and Methods Retrospective study including adults diagnosed with neurosyphilis at IRCCS San Raffaele Scientific Institute, Milan, Italy (January 2010–July 2025). Diagnosis required suggestive clinical presentation, reactive nontreponemal and treponemal serology, and CSF abnormalities. Data were collected from electronic medical records. Clinical outcome at 3 months was described as improved, stable, or worsened based on changes in neurological/ocular manifestations after treatment. Relapse was defined as recurrence of symptoms or new increase in nontreponemal titres after initial response. Continuous variables are reported as median (interquartile range, IQR) and categorical variables as percentage.Results Overall, 92 cases of neurosyphilis were diagnosed, but complete data were available for 61 ( table 1). Median age was 54 years (IQR 43–63), 49 (80.3%) were male. People with HIV (PWH) were 23 (37.7%, table 2). Systemic symptoms were described in 22 (36%). Neurological involvement occurred in 25 (41%) and ocular involvement in 41 (67.2%), respectively. Eight people (13.1%) manifested both neurological and ocular manifestations (figure 1). Serum rapid plasma reagin (RPR) titres were ≥1:32 in 65.6%, Treponema pallidum haemagglutination assay (TPHA) titres were ≥1:5120 in 83.6%. CSF analysis (n=46) showed mild pleocytosis (11cells/mm3, IQR 5–22), moderately elevated protein levels (57mg/dL, IQR 39–79), preserved glucose concentration (58mg/dL, IQR 53–65). CSF TPHA was positive in 40 cases, fluorescent treponemal antibody absorption (FTA-ABS) in 22, and Venereal Disease Research Laboratory (VDRL) in 13. Neuroimaging (n=55) revealed abnormalities in 36 (65.5%), mainly nonspecific. Intravenous therapy lasted a median of 14 days (IQR 14–14), with penicillin being administered to 35 (57.4%) and ceftriaxone to 26 (42.6%). Within 3 months, clinical improvement was observed in 43 (70.5%) cases, 16 (26.2%) were stable, 1 (1.6%) worsened due to retinal necrosis, 1 (1.6%) died for other reason. Improvement rates were similar in PWH (ocular 90.9%/neurological 81.3%) and HIV-negative individuals (ocular 83.3%/neurological 82.6%). Relapse occurred in 5 (8.1%) within 12 months.Conclusions In our cohort, neurosyphilis showed heterogeneous neurological and ocular manifestations, high plasma treponemal titres and relatively mild CSF inflammation. Neuroimaging abnormalities were nonspecific. Although appropriate therapy achieved positive overall outcomes, more than one-quarter didn’t improve, likely reflecting delayed diagnosis or irreversible neurological/ocular damage at presentation, underlying the substantial burden of persistent deficits.Abstract P111 Table 1Demographic, clinical features, laboratory findings, treatment regimens, and outcomes of 61 individuals diagnosed with neurosyphilisAbstract P111 Table 2Baseline characteristics of people with HIV diagnosed with NeurosyphilisAbstract P111 Figure 1Clinical spectrum of neurological and ocular involvement