Prevalence Of And Risk Factors For Neurosyphilis In Syphilitic Patients With Persistently Positive RPR Tests

ObjectiveTo understand the incidence of neurosyphilis and related influencing factors in syphilitic patients with persistently positive RPR tests,and to provide evidence for the early diagnosis and treatment of neurosyphilis.MethodsThis study was retrospectively analyzed for syphilitic patients with persistently positive RPR tests who diagnosed and(or)treated in our hospital from November 2014 to January 2019.1.Clinical data collectionThe patients'gender,age,first clinical manifestations for syphilis,disease period,previous treatment of syphilis,the duration of positive RPR,etc.2.Laboratory examinationBlood tests:RPR and TPPA,T cell subsets,anti-nuclear antibody series,IgG,albumin,HIV antibody test,etc.Cerebrospinal fluid examination:cerebrospinal fluid routine tests,IgG,cerebrospinal fluid biochemistry,RPR and.TPPA.3.Imaging examinationCT,MR,MRA,etc.4.Analysis of high risk factors of neurosyphilisUnivariate and multivariate methods were used to analyze the risk factors of neurosyphilis and the risk factors of symptomatic neurosyphilis,such as the duration of positive RPR,initial RPRtiters,age,gender and so on.5.Case analysis and discussion of neurosyphilis Results1.45 patients were enrolled in the study with slightly more men than women,the average age is 41.87±13.89 years old.The average duration of syphilis was 28.27±26.94 months,the longest was10 years,and the shortest was 6 months.In the history of visit prostitutes,there are 24.44%patients recognized the history of visit prostitutes,and 57.78%patients are unknown.2.Syphilitic patients with persistently positive RPR tests their initial RPR titers are mainly concentrated between 1:8-1:32.After treatment,the RPR titers were mainly concentrated at about1:8.Their CD3~+cell count and CD4~+cell count were significantly lower than the healthy control group(P<0.01).Among the 45 patients,in cerebrospinal fluid examination,there were 10 patients(22.22%)with abnormal white blood cells count,15 patients(33.33%)with abnormal IgG index,and 22 patients(48.89%)with abnormal syphilis serum test.3.Neurosyphilis patients were mainly male,older than non-neurosyphilis patients,and the continuous positive serum RPR titer was higher than that of non-neurosyphilis patients(P< 0.05).The CD4~+and CD3~+cell counts were significantly lower than those in the non-neurosyphilis group(P<0.01).The age of symptomatic neurosyphilis was higher than that of asymptomatic neurosyphilis.4.The results of imaging mainly showed the brain atrophy,multiple ischemic stenosis,brain parenchymal ischemia,cerebral hemorrhage and other imaging findings.Conclusions1.Patients with persistent positive RPR were in the state of immunosuppression,especially those with neurosyphilis.2.The incidence of neurosyphilis was higher in syphilitic patients with continuous higher serum RPR titer after treatment.3.Neurosyphilis can occur in any period of syphilis,with a variety of clinical and imaging manifestations.Early diagnosis and standard treatment can achieve good therapeutic effects.