(P399) The full clinical spectrum of symptomatic neurosyphilis

Background: Neurosyphilis as one of the most feared complications of syphilis, which the disastrous consequences of late neurosyphilis should not be ignored. Lumbar puncture is not suitable for all patients with syphilis, and the clinical manifestations of neurosyphilis are varied and lack specific clinical features. The aim of this study was to describe the whole clinical feature of neurosyphilis in Chinese patients, in an attempt to find specific clinical features and help in the early identification of neurosyphilis.



Methods: This was a retrospective cohort involving 3543 patients with neurosyphilis who visited Shanghai Skin Disease Hospital between 2009 and 2020.



Results: Of the 3543 patients with neurosyphilis, the median age at diagnosis was 56 years. In total, 2117 (59.8%) and 1426 (40.2%) were asymptomatic and symptomatic for neurosyphilis, respectively. Compared with asymptomatic neurosyphilis, those who with symptomatic neurosyphilis were significantly more likely to be older, male, be co-infected with other STDs, have diabetes, autoimmune disease, and cancer (P< 0.001). General paresis was the most common type of symptomatic neurosyphilis (47.1%). Furthermore, 33.6% of symptomatic neurosyphilis patients suffered from more than two clinical types. The clinical manifestations of symptomatic neurosyphilis included psychiatric and neurotic symptoms, among which general paresis predominantly presented as psychiatric symptoms such as affective and memory disorder. Tabes dorsalis often presented as limb anesthesia and other neurotic symptoms. One hundred and fifty-three patients in symptomatic neurosyphilis presented with candy sign, a rare and specific neurosyphilis symptom that is common in general paresis. Girdle sensation was presented in 14 patients, mainly with tabes dorsalis, which has not been reported in previous studies.



Conclusions: General paresis was the most common type of symptomatic neurosyphilis and more patients presented with more than one clinical type of neurosyphilis. Our data suggest that in addition to affective and memory disorder, which are clinically similar to other neuropsychiatric disorders, candy sign may be a specific symptom of neurosyphilis，especially in patients with general paresis; this has rarely been reported previously. In addition to the common symptoms such as limb anesthesia, limb weakness, a lightning-like pain of limbs in patients with tabes dorsalis, girdle sensation is one of the rare symptoms.