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Today I am going to explain  Syphilis: CSF collection shows whether bacteria have reached the nervous system

 by Lucinete Messina Neuroscientist of behavior - USP

Examination is the diagnosis of neurosyphilis and is indicated;

Have you ever had the feeling that you left the doctor's office worse than you did? Some patients, who are worried about the diagnosis of syphilis and the prescription of penicillin injections, are still asked to take the CSF test! But, do you know what it's for? Learn more about syphilis and neurosyphilis and understand when this test should be done.

Although identified thousands of years ago, syphilis persists as a common sexually transmitted disease to this day. According to the STD / AIDS Epidemiological Bulletin, made by the State Secretariat of Health and Health, only 8333 cases of syphilis acquired in 2013 were reported in the state of São Paulo.

Syphilis is a disease transmitted from person to person (or from pregnant to the baby, in congenital syphilis) through any type of contact with mucocutaneous lesions, usually present in the genital and anal regions, but can also be found in the mouth and in the skin. This explains why people who used condoms but practiced unprotected oral sex may be surprised by syphilis.

The infection can occur anywhere there is inoculation of Treponema pallidum, leading to the formation of painless cancer that even untreated and disappears in a few weeks. This stage is called primary syphilis. The incubation period (time between infection and onset of this symptom) ranges from 10 to 90 days.

Syphilis develops in stages, and it is possible to infect sexual partners (or the fetus) at any stage of the disease. After the spontaneous involution of the cancer of the primary syphilis, they pass weeks to months without symptoms. Secondary syphilis occurs, a phase of the disease that can (but is not necessarily) occur with several symptoms: fever, red patches on the body, especially on the palms of the hands and soles of the feet, enlargement of the lymph nodes, asthenia, myalgia, Hair loss and malaise. Even if untreated, these symptoms also regress spontaneously.

Syphilis then passes into the latent phase, with no symptoms and can last for years.

Neurosyphilis

At any stage of the disease there may be central nervous system involvement. The so-called recent neurosyphilis is generally asymptomatic, and only the CSF scan is capable of making this diagnosis. It needs to be treated even when there are no symptoms as it can evolve into symptomatic forms.

Late latent late syphilis can lead to complications of syphilis, which can also affect the central nervous system (late neurosyphilis), eyes, heart and large arteries, bones, skin, and other organs. Such complications may appear after a short period of time or take decades to manifest. Often, late syphilis manifests itself without the person having any symptoms in the primary or secondary phases of the disease.

Patients with recent neurosyphilis may be asymptomatic or present the meningovascular form, with mental confusion, behavioral change, headache, nausea. In late forms, there may be brain involvement (parenchymal syphilis) that may resemble even symptoms of strokes, popularly known as "strokes." Late forms of neurosyphilis may occur with dementia. Paralytic dementia is dramatic and not reversible, even with treatment. The tabes dorsalis is the involvement of the spinal cord by syphilis and develops with alterations in the nerve reflexes and alteration of the motor coordination and walking capacity.

Neurosyphilis may still be accompanied by visual impairment, which may occur concurrently or not with central nervous system problems.

Late forms of neurosyphilis are less frequent than recent forms. It is more common in patients infected with HIV. Nonetheless, people not infected with HIV may also develop neurosyphilis. Considering that in these patients the disease usually occurs a few decades after the infection, it is important to remember that research for syphilis is mandatory in all people, including the elderly, with dementia.

In people infected with HIV, syphilis can progress atypical and faster. For this reason, some authors suggest that all HIV-infected patients diagnosed with syphilis should be screened for neurosyphilis. As clinical neurological examination may be normal, only the CSF examination can safely determine whether or not there is involvement of the central nervous system.

Treatment of syphilis depends on the stage of the disease and whether or not the central nervous system or the eye is involved. Treatment of neurosyphilis or ophthalmic impairment requires hospitalization for at least 14 days with intravenous medication. Blood tests allow the diagnosis and monitoring of treatment.

Thus, medical indication for CSF collection in case of syphilis, even when asymptomatic patients are essential for proper treatment and to avoid complications and severe sequelae.

According to the Handbook for Management of Sexually Transmitted Diseases in People Living with HIV, published by the Secretariat of State for Health in 2011, CSF collection is indicated in the following cases:

Patients infected with HIV and diagnosed with syphilis and who have neurological, ocular or syphilis symptoms in other organs

Patient not responding to treatment

Pictures of syphilis of unknown duration

High serological titles

Uncontrolled immunosuppression.

CSF collection is performed by a physician. It is a relatively simple procedure with minimal discomfort. The puncture is performed outpatient, without need of hospitalization, under local anesthesia. CSF is collected with a fine needle inserted into the spinal canal, usually at the lumbar or, if appropriate, in the suboccipital region. Attending a well-hydrated examination may make it easier to collect. Some people may experience headaches after puncture - if severe or long lasting, it is advisable to seek medical advice.

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P.S. I have this article in portuguese just ask