Neurosyphilis Quiz

Update on Treatment, Prognosis, and Basic Research in Neurosyphilis

• Treatment guidelines for neurosyphilis have been released by the United States, the United Kingdom, Europe, and China.

• Penicillin is preferred worldwide as front-line therapy for neurosyphilis and is the only treatment modality certified for pregnant women with syphilis.

• Ceftriaxone might be an alternative treatment to penicillin, but the efficacy of different therapies is still a major concern.

• Steroids were recommended in some guidelines to prevent the Jarisch-Herxheimer reaction, which may occur within the first 24 hours of neurosyphilis treatment.

• Serofast, a lack of serological response to antisyphilitic therapy, is currently a major concern for clinicians.

• Several factors influence the prognosis of patients with neurosyphilis, such as diplopia, severe atrophy of brain parenchyma, and headache.

• Reinfection of syphilis is more prevalent in MSM and PLWH, and molecular studies are necessary to determine whether the rise in RPR titer is due to reinfection or recurrence.

• Recent basic research on neurosyphilis mainly focuses on the pathogenic mechanisms of neurosyphilis, and the potential biomarkers for diagnosis or prognosis monitoring.

• T. pallidum crosses the endothelial barriers through interjunctional penetration, disseminating throughout the body and invading various organs.

• T. pallidum can activate both humoral and cellular immunity, but cellular immunity is significantly suppressed in the late stage of infection.

• Host immune response also plays an important role in the pathogenesis of neurosyphilis, mainly in the form of T cell-mediated delayed-type hypersensitivity.

• Recent studies propose that CXCL13/CXCR5 mediated the accumulation of B cells and immunoglobulin G in the CSF of neurosyphilis patients; IL-17 not only mediated the inflammatory response but also activated endothelial contraction and destroyed the tight junctions of the BBB.Recent Advances in Neurosyphilis: Epidemiology, Clinical Manifestations, Laboratory Findings, Comorbidities, Diagnosis, Treatment, Prognosis, and Basic Research

• The incidence of neurosyphilis has been increasing in recent years, mainly in MSM.

• Neurosyphilis can mimic most neuro-ophthalmic, audio-vestibular, and psychiatric disorders.

• Comorbidities of neurosyphilis are prevalent and variable, and patients may present with specific metabolic characteristics.

• Clinical diagnostic methods remain immature.

• Recent studies on long non-coding RNA, miRNA, chemokines, and metabolites in peripheral blood and CSF may facilitate the research on the pathogenesis and new indicators of neurosyphilis.

• The resistance of T. pallidum to penicillin has not been discovered.

• Ceftriaxone was found to be more effective than penicillin in some studies, but few large randomized controlled trials supported this view.

• Lumbar puncture remains controversial in the diagnosis of neurosyphilis due to its difficulty of implementation and potential risks posed to patients.

• The false-negative and false-positive rates remain high in a single treponemal or nontreponemal test, thus combined use of various diagnostic methods is recommended.

• The cause of serofast is still unclear, and retreatment to serofast patients cannot significantly improve the cure rates.

• Public education, partner notification, and screening projects are time-consuming and difficult to undertake.

• Further research could concentrate on the pathogenesis, standards and guidelines, treatment modalities, JHR and serofast, follow-up, and the prevention of large-scale coinfection in MSM and PLWH.