[Neurosyphilis in the 21st century: a descriptive study in a tertiary hospital in Madrid]

Neurosyphilis can occur at any time following infection by Treponema pallidum and its incidence has increased over recent years. The epidemiological and clinical pattern has undergone a substantial change in the post-antibiotic era.

To describe and analyse the population of patients diagnosed with neurosyphilis at a tertiary hospital in Madrid from January to May 2015.

A retrospective analysis of the following data was performed: demographic, clinical, complementary tests -serology, cerebrospinal fluid (CSF), neuroimaging- and progression of 28 patients diagnosed between 2008 and 2015.

Most of the patients were males (89.3%), Spanish (60.7%), with a mean age of 53 ± 16.4 years. The most frequent forms were asymptomatic (39.3%), followed by ocular syphilis (21%), non-classical forms (14.3%), cognitive deterioration and neuropsychiatric alterations (11%). Fifty per cent presented a concomitant infection by human immunodeficiency virus, most of them asymptomatic, with a significant correlation between CD4+ T-cells and asymptomatic neurosyphilis. Only 50% presented VDRL+ in CSF, the diagnosis being based on the clinical features, serology and alterations in CSF (cytobiochemical or serological). Neuroimages were unspecific in most cases. The early and ocular forms were associated to a better clinical course.

With respect to the pre-antibiotic era, an important decrease can be observed in the late-onset forms, as well as the appearance of non-classical forms that can mimic other conditions such as viral encephalitis. Diagnosis is complex and based on the clinical features, the serology and study of CSF, often with a complex interpretation, and thus clinical suspicion plays a fundamental role in the diagnosis.