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Neurosyphilis in the mixed urban–rural community of the Netherlands

Published online by Cambridge University Press:  14 October 2013

Ingrid M. Daey Ouwens*
Affiliation:
Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, the Netherlands
Femke D.H. Koedijk
Affiliation:
The National Institute for Public Health and the Environment, Centre of Infectious Disease Control, Epidemiology and Surveillance, Bilthoven, the Netherlands
Aernoud T.L. Fiolet
Affiliation:
Medical Centre, University of Utrecht, Utrecht, the Netherlands
Maaike G. van Veen
Affiliation:
The National Institute for Public Health and the Environment, Centre of Infectious Disease Control, Epidemiology and Surveillance, Bilthoven, the Netherlands
Kees C. van den Wijngaard
Affiliation:
The National Institute for Public Health and the Environment, Centre of Infectious Disease Control, Epidemiology and Surveillance, Bilthoven, the Netherlands
Willem M.A. Verhoeven
Affiliation:
Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, the Netherlands
Jos I.M. Egger
Affiliation:
Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, the Netherlands Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, the Netherlands
Marianne A.B. van der Sande
Affiliation:
The National Institute for Public Health and the Environment, Centre of Infectious Disease Control, Epidemiology and Surveillance, Bilthoven, the Netherlands Julius Centre for Health Sciences and Primary Care Utrecht, the Netherlands
*
I.M. Daey Ouwens, Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Stationsweg 46, 5803 AC Venray, the Netherlands. Tel: +00 314 7852 7339; Fax: +00 314 7852 7110; E-mail: idaeyouwens@vvgi.nl

Abstract

Objective

Neurosyphilis is caused by dissemination into the central nervous system of Treponema pallidum. Although the incidence of syphilis in the Netherlands has declined since the mid-1980s, syphilis has re-emerged, mainly in the urban centres. It is not known whether this also holds true for neurosyphilis.

Methods

The epidemiology of neurosyphilis in Dutch general hospitals in the period 1999–2010 was studied in a retrospective cohort study. Data from the Dutch sexually transmitted infection (STI) clinics were used to analyse the number of patients diagnosed with syphilis in this period.

Results

An incidence of neurosyphilis of 0.47 per 100 000 adults was calculated, corresponding with about 60 new cases per year. This incidence was higher in the western (urbanised) part of the Netherlands, as compared with the more rural areas (0.6 and 0.4, respectively). The number of patients diagnosed with syphilis in STI clinics increased from 150 to 700 cases in 2004 and decreased to 500 new cases in 2010. The sex ratio was in favour of men, yielding a percentage of 90% of the syphilis cases and of 75% of the neurosyphilitic cases. The incidence of neurosyphilis was highest in men aged 35–65 years, and in women aged 75 years and above. The most frequently reported clinical manifestation of neurosyphilis was tabes dorsalis. In this study, 15% of the patients were HIV seropositive.

Conclusion

The incidence of neurosyphilis in a mixed urban–rural community such as the Netherlands is comparable to that in other European countries. Most patients are young, urban and men, and given the frequent atypical manifestations of the disease reintroduction of screening for neurosyphilis has to be considered.

Type
Original Articles
Copyright
Copyright © Scandinavian College of Neuropsychopharmacology 2013 

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