Early symptomatic neurosyphilis and ocular syphilis: A comparative study between HIV-positive and HIV-negative patients

Vero Rasoldier (1) , J. Gueudry (2) , C. Chapuzet (1) , B. Bodaghi (1) , M. Muraine (1) , R. Tubiana (3) , L. Paris (3) , M. Pestel-Caron (1) , F. Caron (1) , E. Caumes (4)

1 Hôpital Charles Nicolle [Rouen]
2 ESCAPE - Epidémiosurveillance de protozooses à transmission alimentaire et vectorielle
3 CHU Pitié-Salpêtrière [AP-HP]
4 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique

Objectives: Since the 2000s, there has been an increase in prevalence of neurosyphilis (NS) and ocular syphilis (OS). As data about symptomatic NS/OS is limited, this study aims to assess the characteristics of symptomatic NS/OS, according to HIV status. Methods: We compared the clinical and biological presentation of early symptomatic NS/OS and its outcome in HIV-positive and HIV-negative patients. Results: Ninety-six patients (93% men, 49% HIV-positive) were included from 2000 to 2016 in two centers, with 67 (69%) having OS, 15 (16%) NS, and 14 (14%) both. HIV-positive patients were younger (P = 0.006) and more likely to be males having sex with males (P = 0.00048) or to have a history of syphilis (P = 0.01). Among 81 OS, there were 43 posterior uveitis (57%), and bilateral involvement was more common in HIV-positive patients (62% versus 38%, P = 0.045). Among 29 NS there were 21 cases of cranial nerve involvement (72%), seven meningitis (24%) and 11 paresthesia (38%). Involvement of the VIIIth cranial nerve was the most common (16 cases). Treponemal tests were more commonly found positive in cerebrospinal fluid in HIV-positive patients (88% versus 76%, P = 0.04). Visual acuity (VA) always improved after treatment (initial VA logMAR 0.8 ± 0.8 versus 0.1 ± 0.1 at 3 months), but 32% and 18% of the patients still had neurological or ocular impairment respectively six and 12 months after treatment. Non-treponemal serological reversion was observed in 43/50 patients (88%) at six months. Conclusion: HIV infection has no consequence on the outcome of NS and OS. Sequelae are common, emphasizing the importance of prevention, and screening, and questioning enhanced treatment.

Mots clés: ocular syphilis; neurosyphilis; syphilis; HIV; ocular syphilis

Domaines: Maladies infectieuses; Santé publique et épidémiologie

Vero Rasoldier, J. Gueudry, C. Chapuzet, B. Bodaghi, M. Muraine, et al.. Early symptomatic neurosyphilis and ocular syphilis: A comparative study between HIV-positive and HIV-negative patients. Infectious Diseases Now, 2021, 51 (4), pp.351-356. ⟨10.1016/j.medmal.2020.10.016⟩. ⟨hal-03238856⟩