Doctors seeing more atypical, severe symptoms in patients with syphilis

Physicians are increasingly seeing cases of syphilis that do not present with typical symptoms, such as rash or skin ulcers, according to a new report presented last week at the 2024 Epidemic Intelligence Service Conference in Atlanta.

Instead, patients are presenting with headaches or disruptions in their vision or hearing, said a team co-led by Amy Nham, Pharm.D., M.P.H. Nham is a first-year epidemic intelligence service officer assigned to the Chicago Department of Public Health.

Nham and two co-authors gave an overview of these "neurologic, ocular, and otic (NOO)" forms of syphilis, which can often be severe. The team found 36 potential NOO syphilis cases in the Chicago area, reported between January and August of 2023. Twenty involved a brain-targeted neurosyphilis, 17 were syphilis affecting the eyes, and one case involved hearing.

Men were most likely to be affected, with more than half identifying as heterosexual, the team said. NOO syphilis has traditionally most often been seen among HIV-positive people, but in the Chicago cases, two-thirds of those affected were not infected with HIV.

"Signs or symptoms consistent with NOO syphilis were often the only presentation" symptom, the researchers noted. "Clinicians should consider NOO syphilis even in persons presenting without typical syphilis signs and symptoms and persons without HIV."

Speaking with CNN, Nham said that "providers definitely need to be screening more and be aware that this is what we're seeing," adding that "they're not the most specific symptoms, which is why it's really important that providers are doing appropriate screening and asking patients for risk factors," including a patient's sexual history.

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