ArticleAnnals of Indian Academy of Neurology2026
High Titers, Hidden Disease: Asymptomatic Neurosyphilis in Secondary Syphilis - A Case Series from Western Maharashtra.
Article in Annals of Indian Academy of Neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
abstractSyphilis can involve the central nervous system at any stage; however, routine cerebrospinal fluid (CSF) examination is rarely performed in neurologically asymptomatic patients with secondary syphilis. We describe a case series of eight male patients with secondary syphilis and high serum venereal disease research laboratory (VDRL) titers (≥1:16) evaluated at a tertiary teaching hospital in western Maharashtra, India (2024-2025). Five patients were human immunodeficiency virus (HIV)-positive and on antiretroviral therapy. None had neurological symptoms or signs; however, all had CSF abnormalities, consistent with asymptomatic neurosyphilis, including reactive CSF-VDRL in all patients, with mild pleocytosis and/or elevated protein in some. All patients received intravenous aqueous crystalline penicillin G for 14 days, with a serological response observed in most follow-up cases. These findings suggest that high titers in secondary syphilis, particularly in the presence of HIV co-infection and behavioral risk factors, may warrant consideration of CSF evaluation even in the absence of neurological manifestations.
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