Reported Neurologic, Ocular, and Otic Manifestations Among Syphilis Cases-16 States, 2019

Abstract

Background: Syphilis can cause neurologic, ocular, or otic manifestations, possibly resulting in permanent disability or death. In 2018, the Centers for Disease Control and Prevention began collecting syphilis clinical manifestation data via the National Notifiable Diseases Surveillance System. We present the first reported US syphilis neurologic, ocular, and otic manifestation prevalence estimates.

Methods: We reviewed 2019 National Notifiable Diseases Surveillance System data to identify jurisdictions reporting 70% or greater of syphilis cases 15 years or older with clinical manifestation data (considered "complete reporting"). Among these jurisdictions, we determined reported neurologic, ocular, and otic manifestation prevalence, stratified by demographic, behavioral, and clinical characteristics.

Results: Among 41,187 syphilis cases in 16 jurisdictions with complete reporting, clinical manifestations were infrequently reported overall: neurologic (n = 445, 1.1%), ocular (n = 461, 1.1%), otic (n = 166, 0.4%), any (n = 807, 2.0%). Reported clinical manifestation prevalence was highest among cases 65 years or older (neurologic, 5.1%; ocular, 3.5%; otic, 1.2%) and those reporting injection drug use (neurologic: 2.8%; ocular: 3.4%; otic: 1.6%). Although reported neurologic and ocular manifestation prevalence was slightly higher among human immunodeficiency virus (HIV)-infected versus HIV-negative persons, approximately 40% of cases with manifestations were HIV-negative. Reported otic manifestation prevalence was similar regardless of HIV status. When stratifying by HIV status and syphilis stage, reported prevalence was highest among HIV-infected persons with unknown duration/late syphilis (neurologic, 3.0%; ocular, 2.3%; otic, 0.7%).

Conclusions: Reported neurologic, ocular, and otic manifestation prevalence was low among syphilis cases, but these data are likely an underestimate given potential underreporting. Reported clinical manifestation frequency, including among HIV-negative persons, emphasizes the importance of evaluating all syphilis cases for signs/symptoms of neurosyphilis, ocular syphilis, and otosyphilis.

Figure 1.

Sixteen included states reporting ≥70% of syphilis cases (all stages) with neurologic, ocular, and otic manifestation response values that were not missing or unknown, 2019.

Figure 2.

Prevalence of reported neurologic, ocular, and otic manifestations by HIV status and syphilis stage (Panel A), race/Hispanic ethnicity (Panel B), injection drug use in the past 12 months (IDU) (Panel C), and sex and sex of sex partners (Panel D) among syphilis cases (all stages) reported by jurisdictions with complete reporting, 2019. Values shown for prevalence represent the total of verified, likely, and possible neurologic, ocular, and otic clinical manifestations. A total of 16 states reporting ≥70% of syphilis cases with clinical manifestation response values that were not missing or unknown were considered to have complete reporting. Syphilis cases ≥15 years of age were included in this analysis. Approximately 25% of cases were missing HIV status. Early syphilis was defined as those cases assigned a syphilis surveillance stage of primary, secondary, or early non-primary non-secondary, and late syphilis was defined as those cases staged as unknown duration or late. Of note, >40% of cases were missing IDU status. The men who have sex with men (MSM) category included gay, bisexual, and other MSM while the men who have sex with women (MSW) category included men who reported only having sex with women. Complete supporting data for this figure are available in Table 1, Supplemental Digital Content 1.