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RESEARCH ARTICLE

Clinical characteristics of neurosyphilis in people with and without HIV infection: a stratified analysis by symptom status

Shi Zou https://orcid.org/0000-0003-0681-5123 A B # , Jie Liu A # , Xi Liu C # , Zhengxi Song D , Shihui Song A , Miao Tan A , Qianhui Chen A , Qian Du A , Mingqi Luo A , Wei Guo E F * and Ke Liang A B G *
+ Author Affiliations
- Author Affiliations

A Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China.

B Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China.

C Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China.

D Department of Neurology, The People’s Hospital of Jianyang City, Sichuan, China.

E Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China.

F Department of Pathology, School of Basic Medical Sciences, Wuhan University, Wuhan, China.

G Department of Nosocomial Infection Management, Zhongnan Hospital of Wuhan University, Wuhan, China.


# These authors contributed equally to this paper

Handling Editor: Michael Marks

Sexual Health 22, SH25053 https://doi.org/10.1071/SH25053
Submitted: 27 March 2025  Accepted: 19 September 2025  Published: 13 October 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing

Abstract

Background

Neurosyphilis (NS) is experiencing a resurgence globally, particularly with higher incidence rates among people living with HIV (PLWH). However, due to the diversity of symptoms associated with NS, especially among PLWH, the diagnosis and treatment of NS still present certain challenges.

Methods

We retrospectively analyzed data from the clinical records of NS patients between December 2016 and December 2022 in Zhongnan Hospital of Wuhan University and The People’s Hospital of Jianyang City. The clinical and laboratory data were collected among PLWH and HIV-negative patients.

Results

A total of 80 patients (53 PLWH and 27 HIV-negative patients) were included in the study. The median age of PLWH was 32 years (IQR 27–44 years), and 94% of participants were men. Among HIV-negative patients, the median age was 40 years (IQR 32–48 years), 81% were men. A total of 10 (19%) PLWH had a history of syphilis, whereas none of the HIV-negative patients had a history of syphilis. Visual impairment was the most common clinical symptom in PLWH (33%), whereas a decrease of muscle strength was the most common clinical symptom in HIV-negative patients (29%). No differences of laboratory features and outcome were found between these two groups. In both groups, cerebrospinal fluid white blood cell count, cerebrospinal fluid protein concentration and the proportion of participants with abnormal brain imaging were significantly higher in the symptomatic NS patients than that in the asymptomatic NS patients.

Conclusion

Despite the similar outcome of NS in PLWH and HIV-negative populations, the primary symptoms still differ, highlighting the need for enhanced diagnostic methods, the ability to recognize NS early and provision of timely interventions.

Keywords: asymptomatic NS (ANS), cerebrospinal fluid, clinical features, HIV, laboratory features, neurosyphilis (NS), people living with HIV (PLWH), symptomatic NS (SNS).

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