ID-5184 Wonca Abstracts supplement L-Z 13-10-23 - Flipbook - Page 35
WONCA 2023 Supplement 2: WONCA 2023 abstracts (L–Z)
L
M
N
Progressive neurological deterioration during a primary care
consultation: Is it the great pretender?
O
Dr Yen Li Lim
P
Q
R
S
T
U
V
W
X
Y
Z
Sexual Health Service, Royal Prince Alfred Hospital
This session uses an interesting neurosyphilis case, with significant progressive neurological
deterioration, to educate the audience on the general principles of syphilis testing, diagnosis and
treatment, and specific investigations for neurosyphilis diagnosis and treatment.
Syphilis is a sexually transmissible infection caused by the bacterium Treponema palladium. In 2020,
there were an estimated seven million new syphilis infections globally. While men who have sex with
men still carry a higher burden of disease, rates of syphilis in heterosexual populations have been
increasing. Neurosyphilis, infection of T. palladium in the cerebrospinal fluid (CSF), can occur at any
stage of syphilis infection. Increased syphilis infection numbers may result in higher neurosyphilis
cases. Neurosyphilis can present with variable neurological symptoms. While CSF examination
remains the mainstay of diagnosis, clinical suspicion with assessment of pretest probability is
equally important.
Internationally, primary healthcare practitioners are the first point of contact with healthcare services.
They are the first clinicians to assess sometimes complex symptoms, and are well-placed to assess
for, diagnose, treat and follow up syphilis infections early, including neurosyphilis.
The case study is a 63-year-old man who has sex with men, living with human immunodeficiency
virus on anti-retroviral therapy. He reported two weeks of bilateral visual changes with photophobia,
polyarthritis and weakness. At presentation, he also had ataxia and reported cognitive changes. His
motor symptoms worsened during the consultation and he was unable to mobilise independently
on transfer to emergency. CSF results were diagnostic for neurosyphilis. He was treated with
benzylpenicillin 1.8 g intravenously every four hours for 12 days. Due to reported side effects, he had
ceftriaxone intravenously 2 g daily to complete a 15-day treatment course.
The goals are to provide education and resources, and to increase the confidence of primary
healthcare practitioners to test, diagnose, treat and follow up syphilis cases.
33