Incidence of syphilitic hepatitis among patients with neurosyphilis

Syphilis is a sexually transmitted infection of ongoing public health concern due to its systemic complications, which necessitate early detection and management. As a non-hepatotropic pathogen, syphilis can also cause unexplained hepatitis, a condition that is often overlooked. A retrospective review of 62 patients with neurosyphilis at a metropolitan Australian hospital found that nine (15%) had abnormal liver biochemistry, which improved with antibiotic therapy, consistent with syphilitic hepatitis. This improvement was statistically significant across all liver markers, and the liver pattern of injury was predominantly cholestatic (67%). This study aims to alert clinicians to the incidence and patterns of liver biochemistry abnormalities in syphilis and advise clinicians to perform liver function testing in all patients with neurosyphilis, particularly in high-risk groups. Early detection and diagnosis can prevent unnecessary tests, enable prompt treatment and avoid progression to fulminant hepatitis.