A consequence of the syphilis epidemic among men who have sex with men (MSM): Neurosyphilis in Los Angeles, 2001-2004

Objectives: To describe the epidemiology and clinical findings of neurosyphilis (NS) cases diagnosed during the current syphilis epidemic occurring predominantly among men who have sex with men. Methods: Syphilis cases reported to the health department were reviewed for diagnosis of NS, cerebrospinal fluid venereal disease research laboratory results, and/or treatment for NS. Results: During 2001-2004, 7083 cases of syphilis were diagnosed in Los Angeles. One hundred nine cases of confirmed or probable NS occurring among persons aged 19 to 65 years were identified during this period (1.5%). Symptomatic NS was present in 1.2% of reported syphilis cases (86 of 7083). NS cases were inclusive of 71 (65%) men who have sex with men. Forty-two (49%) of the symptomatic NS cases occurred during secondary (N = 28) or early latent (N = 14) syphilis. Sixty-eight percent (N = 74) of the NS cases were human immunodeficiency virus (HIV)-positive. The estimated incidence of symptomatic NS among HIV-infected persons with early syphilis was 2.1% as compared with 0.6% among HIV-negative persons. Conclusion: Providers should maintain a high index of suspicion for NS among patients with syphilis, particularly those with HIV infection.