Friday 4 April 2014
A world expert on neurosyphilis has told British sexual health specialists that HIV+ patients may be at particular risk of neurosyphilis because of their impaired immune systems.
Dr. Christina Marra, Professor of Neurology at the University of Washington, was speaking to delegates at the joint British HIV Association (BHIVA) and British Association for Sexual Health and HIV (BASHH) Conference in Liverpool (1-4 April 2014).
People with HIV are at increased risk of contracting syphilis, and are more likely to suffer from neurosyphilis, where the bacteria that causes the disease (Treponema pallidum) enters the nervous system and may ultimately damage cells in the brain. HIV+ patients may be at particular risk for neurosyphilis when their T cells are low, and, unlike in people who aren't infected with HIV, the usual treatment for syphilis doesn't prevent this serious syphilis complication. The consequences of neurosyphilis can be devastating, leading to deafness, stroke, dementia and blindness.
Professor Marra commented: "When it comes to neurosyphilis, there remains a lot of uncertainty about how to best manage HIV+ patients. We believe that patients with evidence of the bacteria in their cerebrospinal fluid (CSF) are at increased risk and generally treat aggressively, but the value of this approach is yet to be proven.
"In the meantime we are dropping the ball by not asking HIV+ patients with syphilis some simple questions about problems with vision, issues with hearing and changes in thinking. This is a simple way to identify patients who are at greatest risk of neurosyphilis and get them tested for the disease. While all syphilis treatment guidelines recommend lumbar puncture in HIV-infected patients with syphilis who have neurological symptoms, these patients are rarely screened in a systematic way and patients with symptoms can be easily missed."
In recent years there has been a marked increase in cases of syphilis in the US and Europe, with men who have sex with men (MSM) a particularly at risk group. Professor Marra believes that the improved outlook for HIV+ people due to treatment advances may be a cause. She commented: "Treatment optimism is a real factor. It has led to less regard for safe sex, which has let diseases like syphilis back in, which is a real problem for people already HIV+ as their immune systems are less able to control the syphilis bacteria.
"Syphilis is also a problem because skin-to-skin contact can transmit the bacteria, so oral sex without a condom can lead to an infection. We need to tell patients to use a condom, but also conduct regular testing for those at risk, so we catch any disease early and can act accordingly.
"The stigma that still surrounds syphilis is huge and enduring. I have patients who preferred telling their family they had HIV than syphilis. This suggests that we need to do a better job educating at risk people about syphilis and its complications."
Professor Marra was recently given the Annual Achievement Award by the American Sexually Transmitted Diseases Association, in recognition of an outstanding body of research in sexually transmitted diseases.
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BHIVA is the leading UK professional association representing professionals in HIV care. Founded in 1995, it is a well-established and highly respected organisation with national influence committed to providing excellence in the care of those living with and affected by HIV. BHIVA acts as a national advisory body to professions and other organisations on all aspects of HIV care. BHIVA also provides a national platform for HIV care and is represented on international, national and local committees dealing with HIV care. In addition, BHIVA works to promote undergraduate, postgraduate and continuing medical education within HIV care. Visit www.bhiva.org for more information about BHIVA, and follow us on Twitter @BritishHIVAssoc
The British Association for Sexual Health and HIV (BASHH) is the lead professional representative body for those managing STIs and HIV in the UK. It seeks to innovate and deliver excellent tailored education and training to healthcare professionals, trainers and trainees in the UK, and to determine, monitor and maintain standards in provision of sexual health and HIV care. http://www.bashh.org/