06 Nov Improving the Diagnosis and Treatment of Neurosyphilis

MedicalResearch.com Interview with:

Sagar Patel

Sagar S. Patel, MBS
Department of Medical Education
Geisinger Commonwealth School of Medicine
Scranton, PA 18509

MedicalResearch.com: What was the background for this research?

Response: Syphilis is a sexually transmitted infection that is caused by a gram-negative bacterium called Treponema pallidum. This infection promotes the cell death of microglia and can cause a variety of symptoms. It is commonly observed in developing countries such as sub-Saharan Africa. Neurosyphilis is a complication of syphilis that affects the central nervous system (CNS).

The CNS undergoes multiple stages of deterioration and can include personality changes and hearing abnormalities. Diagnosing neurosyphilis is challenging because its symptoms mimic other neurodegenerative diseases. Diagnosis relies on clinical studies, cerebrospinal fluid (CSF) analysis, and neuroimaging techniques.

MedicalResearch.com: What were the main findings?

Response: This focused review analyzed the different ways in which neurosyphilis is detected and its treatment options. There are five stages of neurosyphilis that range in symptoms. Asymptomatic neurosyphilis is the most common stage. Meningeal neurosyphilis occurs when cranial nerves VII, VIII, VI, and II are affected. Meningovascular neurosyphilis occurs when the meninges are inflamed, which leads to strokes. Enhanced activity of fibroblasts is also seen in this stage. Syphilitic paresis occurs when patients undergo paralysis. Tabes dorsalis occurs when the roots of the spinal cord disintegrate.

Currently, there is no standard method to diagnose neurosyphilis. The most reliable way to test for this condition quantitatively would be utilizing CSF analysis. This is performed by a lumbar puncture to collect the CSF. One of the main imaging techniques is magnetic resonance imaging (MRI). This imaging method is beneficial because this method does not expose patients to radiation. Single-photon emission computed tomography (SPECT) is commonly used in a clinical setting. SPECT utilizes a probe, which is injected into the patient’s bloodstream and gets absorbed by specific tissues. A cross-sectional study analyzed the effectiveness of this imaging method. They were able to monitor the recovery of neurosyphilis in patients using this technique.

There are two treatment options for neurosyphilis: penicillin G and ceftriaxone. Ceftriaxone is utilized if the patient is allergic to penicillin G. Despite the potency of ceftriaxone being less than penicillin G, it is still an effective pharmacotherapy. Penicillin G and ceftriaxone enhance brain outcomes in imaging.

MedicalResearch.com: Were there any limitations?

Response: There is no gold standard for detecting neurosyphilis, which is an issue. There needs to be better detection methods that will specifically detect neurosyphilis. Neurosyphilis does not have a clear pattern which results in neurological damage, however, neuroscientists are interested in analyzing the hippocampus, amygdala, and thalamus. Researchers should focus on discovering biomarkers that will become an acceptable gold standard in the future diagnosis of this infection. More treatment options should be available to the public, especially those that are allergic to ceftriaxone. Future implementation science studies focused on educating developing countries on this infection and how to prevent it are urgently needed.

Citation

Patel SS, et al. Analysis of neurosyphilis imaging methods and treatment: A focused review. Cureus 2024-in press. https://www.cureus.com/articles/306035-analysis-of-neurosyphilis-imaging-methods-and-treatment-a-focused-review?token=GcAc_Kdswydm69xchR6p&utm_medium=email&utm_source=transaction#!/

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Last Updated on November 6, 2024 by Marie Benz MD FAAD