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Neurosyphilis Presenting with Papillitis
Martin Edward Perry1, Sarah Cooper2, Shona Corry2
1Department of Rheumatology, Royal Alexandra Hospital, Paisley, UK.
Abstract:
Syphilis is one of the oldest described infectious diseases in the world and is caused by the spirochete bacterium Treponema pallidum [1]. Although now a rare disease, incidence is increasing with the number of diagnoses of the disease rising in England from 1688 to 2713 between 2003 and 2012 (a 61% increase)[2]. Major outbreaks of syphilis have been documented in London, Manchester, Dublin, and Brighton particularly among men who have sex with men (MSM)[3]. Diagnosis remains difficult on account of multi-system symptoms, duration of the condition, and social stigma.
Learning Points:
Normal CSF pressure with indistinct optic disc margins suggests papillitis, not papilloedemaNeurosyphilis can cause various ocular symptoms and is a cause of unexplained high ESRWhen treating with penicillin, the physician should be aware of a potential Jarish-Herzheimer reaction.
Insights
Syphilis, caused by Treponema pallidum, is an increasing infectious disease. Diagnosis is challenging due to varied symptoms, chronicity, and stigma, particularly affecting men who have sex with men.
Area of Science:
- Infectious Diseases
- Bacteriology
- Public Health
Background:
- Syphilis is an ancient infectious disease caused by the bacterium Treponema pallidum.
- Recent data indicates a significant rise in syphilis diagnoses in England between 2003 and 2012.
- Outbreaks have been noted in major UK cities, predominantly among men who have sex with men (MSM).
Purpose of the Study:
- To highlight the increasing incidence of syphilis.
- To discuss diagnostic challenges associated with syphilis.
- To inform healthcare providers about neurosyphilis and treatment considerations.
Main Methods:
- Review of historical and recent epidemiological data on syphilis incidence.
- Analysis of diagnostic difficulties including multi-systemic presentation and social stigma.
- Discussion of clinical presentations such as ocular symptoms and cerebrospinal fluid findings.
Main Results:
- Syphilis incidence increased by 61% in England from 2003 to 2012.
- Diagnosis is complicated by the disease's varied symptoms, long duration, and associated stigma.
- Neurosyphilis can manifest with diverse ocular symptoms and may present with elevated ESR.
Conclusions:
- Papillitis, not papilloedema, is suggested by normal CSF pressure and indistinct optic disc margins.
- Neurosyphilis is a significant cause of ocular symptoms and unexplained high ESR.
- Physicians must consider the potential for Jarisch-Herxheimer reactions during penicillin treatment for syphilis.
