Objective:

To describe the demographic, clinical, and ancillary diagnostic characteristics of neurosyphilis and to identify factors associated with distinct clinical phenotypes in patients treated at a tertiary care center in Bogotá, Colombia from 2023 to 2025

Background:

The diagnosis of neurosyphilis remains challenging, with the number of cases increasing in Colombia. Characterizing clinical phenotypes across immunosuppressed and non-immunosuppressed populations is crucial to prevent delays in diagnosis and treatment. 

Design/Methods:

Descriptive statistics were used to summarize demographic, clinical, and ancillary test data. Pearson’s correlation coefficient was used to explore associations between serum nontreponemal titers and clinical presentation. All analyses were conducted using SPSS

Results:

Thirty-seven patients with neurosyphilis were included. Thirty-five (94.6%) were male, with a median age of 33 years (IQR 27–41). Nineteen patients (51.3%) were HIV-positive. The most common presenting symptom was headache (n = 15), and the most frequent finding on examination was cranial nerve involvement (n = 14). Fourteen patients (38%) were asymptomatic at the time of diagnosis. The most prevalent clinical phenotype was cranial neuropathy (n = 13); however, other phenotypes such as stroke, meningitis, myelitis, and inflammatory polyneuropathy were also observed. Higher nontreponemal titers correlated with neurosyphilis as the first manifestation of the treponemal infection (r = 0.45, p = 0.007). 

While most patients received penicillin-based regimens (n=28,75.6%), seven (18.9%) received ceftriaxone and two (5.4%) received ceftriaxone plus doxycycline. The primary reason for changing treatment was a transition to home-based care (n=11, 29.7%).

Conclusions:

Neurosyphilis frequently presents asymptomatically, particularly among individuals aware of their HIV-positive status. Although uncommon, rare clinical phenotypes continue to be observed in clinical practice. Most patients received crystalline penicillin; however, alternative regimens such as ceftriaxone and doxycycline were used in some cases due to transitions to home-based care or limitations in medication availability.