How is neurosyphilis prevented?

Updated: Jul 17, 2018
  • Author: Richard P Knudsen, MD, FAAN, FAAP; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Screening measures are the mainstay of therapy. Psychiatric patients are a relatively high-risk group for neurosyphilis. Currently, routine screening (serological) of certain psychiatric patients is justified, especially if they have a substance-related disorder, HIV infection, other sexually transmitted diseases, or clinical signs suggestive of neurosyphilis and if they engage in unprotected sexual activity.

No vaccine is available. Epidemiologic investigation (ie, accurate identification and timely reporting to public health facilities) and preventive treatment of sexual contacts are important. Clinical awareness is the key to prevention. All clinicians and laboratories based in the United States are expected to report, within 48 hours, cases of syphilis to their local or state health department according to established policy. All test results are held in confidence. Partners exposed within the 90 days preceding the patient's diagnosis of primary, secondary, or early latent syphilis should be treated presumptively. Partner notification may have to extend to 2 years for patients with secondary syphilis who have a clinical relapse or those with early latent syphilis. Patients with concomitant HIV infection or those on non-PCN treatment should be monitored for life.

A report from the Canadian Public Health describes the epidemic of infectious syphilis and notes that it primarily centers on men who have sex with men. They plead for the necessity of a coordinated national approach to effectively intervene, especially given the interconnection of urban sexual networks that contribute to the dynamics of transmission. [97]

New diagnostics are needed. Diagnostic priorities include polymerase chain reaction–based tests, less invasive (eg, oral fluid) tests, rapid point-of-care tests (immunochromatographic strips), and serologic tests that differentiate active from adequately treated infections. Recently identified T pallidum immunogens may prove useful for vaccine development.

Research in molecular epidemiological typing is yielding valuable information regarding certain T pallidum subtypes (14d/f) associated with neuroinvasiveness and, thus, which geographic areas are at greater risk for neurosyphilis. The data is also revealing which subtypes of the germ (via a single mutation) revert to macrolide antibiotic resistance. [98]

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