Ndonji Chiwaya1, Mashina Chomba2, Sarah Braun3, Deanna Saylor4
1Internal Medicinie, 2Internal Medicine, University Teaching Hospital Lusaka Zambia, 3University teaching Hospital LUsaka Zambia, 4Neurology, John Hopkin
Objective:
To evaluate the utility of a neurosyphilis screening tool (NST) amongst adults in Zambia who were newly diagnosed with Syphilis.
Background:
Syphilis is common in Zambia, affecting 7% of adults, and often occurs with HIV co-infection which confers a higher risk of neurosyphilis. However, neurosyphilis screening is not commonly undertaken at the time of syphilis diagnosis.
Design/Methods:
We enrolled consecutive adults who tested positive for syphilis at two sexually transmitted infection clinics in Zambia. Participants completed a demographic questionnaire and underwent a medical evaluation by a non-specialist doctor, including NST consisting of ten symptom questions and 12 neurological examination maneuvers. Participants endorsing ≥ 1 symptom or with any exam abnormality were offered lumber puncture(LP) for evaluation of neurosyphilis and then followed three-monthly for one year. We present a descriptive analysis of the cohort.
Results:
We enrolled 262 participants, of which 47% (n=123) were male with average age 34±11 years. Ninety-eight (37%) had HIV co-infection (81% on antiretroviral therapy; median[IQR] CD4 count: 505 [331,663] cells/ul) and 27% (n=71%) reported prior syphilis infection syphilis infection. Twenty-nine (11%) screened positive and were older (44±12 vs 32±10, p<0.001) and more likely to have a prior syphilis infection (62% vs 23%, p<0.001) than those who screened negative. More participant who screened positive also had HIV (52% vs 36%), though this was not significant (p=0.09). Only half of those who screened positive accepted LP, and CSF VDRL was negative in all cases. However, 15 (52%) of those who screened positive were treated for neurosyphilis. Of 4 participants who screened positive and failed treatment at one year, three were not treated for neurosyphilis.
Conclusions:
Symptoms and signs of neurosyphilis were common in this cohort of Zambian adults with syphilis, but limited LP acceptance and laboratory reliability limited evaluation of the accuracy of the NST.
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