A Consequence of the Syphilis Epidemic Among Men Who Have Sex With Men (MSM): Neurosyphilis in Los Angeles, 2001-2004

The authors undertook the current study to examine the epidemiology and clinical findings of neurosyphilis (NS) cases diagnosed during the current syphilis epidemic occurring primarily among MSM. Syphilis cases that were reported to the health department were reviewed for diagnosis of NS, cerebrospinal fluid venereal disease research lab results, and/or NS treatment.

In Los Angeles from 2001 to 2004, 7,083 syphilis cases were diagnosed. During this period, 109 cases of confirmed or probable NS were noted in persons ages 19 to 65. In 1.2 percent of cases (86 patients), symptomatic NS was present. Among the NS cases, 71 (65 percent) were MSM. Of the symptomatic NS cases, 42 (49 percent) occurred during secondary (28 patients) or early latent (14 patients) syphilis stages. Seventy-four (68 percent) of the NS cases were co-infected with HIV. Estimated incidence of symptomatic NS among HIV-positive patients with early syphilis was 2.1 percent, compared with 0.6 percent among HIV-negative patients.

The researchers concluded: "Providers should maintain a high index of suspicion for NS among patients with syphilis, particularly those with HIV infection."

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