DOI: 10.12890/2024_004578
Syphilis should not be overlooked in any individual, irrespective of their condition
Authors
orianecellier@hotmail.fr
Keywords
Neurosyphilis, tetraparetic, sexually transmitted infection, roseoliform exanthema, meningoradiculitisAbstract
Introduction: Syphilis remains a significant challenge in public health, largely because of its diverse clinical manifestations, often resulting in underdiagnosis especially among patients with neurogenic disability.
Case description: We present a case of neurosyphilis in a 63-year-old patient with a spinal cord injury. Despite syphilis being a well-established sexually transmitted infection, the exacerbation of neurological and dermatological symptoms during physical examination prompted an investigation into alternative causes beyond the patient’s pre-existing paraparesis, ultimately resulting in the diagnosis of neurosyphilis.
Conclusion: This case highlights the importance of considering syphilis as a potential diagnosis in individuals regardless of their medical history.
References
- Kojima N, Klausner JD. An update on the global epidemiology of syphilis. Curr Epidemiol Rep 2018;5:24–38.
- Fenton KA, Breban R, Vardavas R, Okano JT, Martin T, Aral S, et al. Infectious syphilis in high-income settings in the 21st century. Lancet Infect Dis 2008;8:244–253.
- Schmidt R, Carson PJ, Jansen RJ. Resurgence of syphilis in the United States: an assessment of contributing factors. Infect Dis (Auckl) 2019;12:1178633719883282.
- Staritsky LE, van Aar F, Visser M, op de Coul ELM, Heijne JCM, Götz HM, et al. Sexually transmitted infections in the Netherlands in 2019. RIVM; 2020 [cited 2024 Feb 4]. Available from: https://rivm.openrepository.com/handle/10029/623857
- Heijstek MW, Goslings WR, Shamelian S. Koorts en exantheem als manifestatie van het secundaire stadium van syfilis [Fever and exanthema as manifestations of the second stage of syphilis]. Ned Tijdschr Geneeskd 2006;150:1342–1346.
- Chen SY, Johnson M, Sunenshine R, England B, Komatsu K, Taylor M. Missed and delayed syphilis treatment and partner elicitation: a comparison between STD clinic and non-STD clinic patients. Sex Transm Dis 2009;36:445–451.
- Bissessor M, Fairley CK, De Guingand D, Bradshaw CS, Chen MY. Delay in the diagnosis of early syphilis among men who have sex with men: need for greater community and health provider education. Int J STD AIDS 2009;20:52–53.
- Ghanem KG, Ram S, Rice PA. The modern epidemic of syphilis. N Engl J Med 2020;382:845–854.
- Moore JE, Faupel M. Asymptomatic neurosyphilis V. A comparison of early and late asymptomatic neurosyphilis. Arch Derm Syphilol 1928;18:99–108.
- Ropper AH. Neurosyphilis. N Engl J Med 2019;381:1358–1363.
- Hamill MM, Ghanem KG, Tuddenham S. State-of-the-art review: neurosyphilis. Clin Infect Dis 2023;78:e57–e68.
- Workowski KA, Bachmann LH. Centers for Disease Control and Prevention’s Sexually Transmitted Diseases Infection Guidelines. Clin Infect Dis 2022;74:S89–94.
- Idsoe O, Guthe T, Willcox RR. Penicillin in the treatment of syphilis. The experience of three decades. Bull World Health Organ 1972;47:1–68.
- Luetkemeyer AF, Donnell D, Dombrowski JC, Cohen S, Grabow C, Brown CE, et al. Postexposure doxycycline to prevent bacterial sexually transmitted infections. N Engl J Med 2023;388:1296–1306.
- Traeger MW, Mayer KH, Krakower DS, Gitin S, Jenness SM, Marcus JL. Potential impact of doxycycline post-exposure prophylaxis prescribing strategies on incidence of bacterial sexually transmitted infections. Clin Infect Dis 2023;ciad488.