DIAGNOSIS OF NEUROSYPHILIS - APPRAISAL OF CLINICAL CASELOAD

Objectives: To review the management of a cohort of patients with posi tive teponemal serology and psychiatric and/or neurological disorders. Methods: A retrospective case note review of 172 patients with positi ve treponemal serology attending the Patrick Clement's Clinic, Central Middlesex Hospital between December 1990 and November 1995 was perfor med. Results: 101 men and 71 women were new attenders diagnosed with p ositive treponemal serology. A neurological problem was identified in 27 patients (12 women and 15 men) with psychiatric and/or neurological disorders, of whom 20 (six women and 14 men) underwent investigation of the cerebrospinal fluid (CSF). With the medical history and results of CSF-RPR and FTA tests, white cell count (WCC), and total protein l evel in the CSF, 10 patients (eight men and two women) were diagnosed with likely neurosyphilis and 17 with neurological disorders not thoug ht to be caused by syphilis. The clinical features in those having neu rosyphilis were sensorineural hearing loss (n = 5) and tabes dorsalis (n = 5). In the seven patients diagnosed with neurosyphilis who underw ent CSF examination one patient had a reactive CSF-FTA, elevated prote in, and elevated WCC; one patient had a reactive CSF-FTA and RPR with elevated protein; the total protein only was elevated in three cases a nd the WCC elevated in one case. Nine of the 10 patients with neurosyp hilis received adequate neurosyphilitic treatment; one patient was los t to follow up. Conclusions: The management of patients with positive treponemal serology and psychiatric and/or neurological disorders was consistent. Patients with suspected neurosyphilis or patients with neu rological signs compatible with neurosyphilis (who did not undergo CSF examination) were treated with adequate neurosyphilitic therapy.