ABSTRACT
To investigate the epidemiology and clinical spectrum of neurosyphilis in a population with high rates of coexisting syphilis and human immunodeficiency virus (HIV) infection, a retrospective analysis of cases in all San Francisco hospitals from 1985 to 1992 was conducted. Neurosyphilis was defined by a newly reactive cerebrospinal fluid VDRL; 117 patients with neurosyphilis were identified. The median age was 39 years, 91% were male, 74 (63%) were white, and 75 (64%) were HIV-infected. Thirty-eight (33%) presented with an early symptomatic neurosyphilis syndrome. Six (5%) had late neurosyphilis. Thirty-eight (32%) patients were asymptomatic, and 35 (30%) had findings attributable to coexisting neurologic diseases. Patients demonstrated high serum nontreponemal (VDRL) titers (median, 1:128) at neurosyphilis presentation. In contrast to the findings from the preantibiotic era, neurosyphilis was identified in young patients most often with HIV coinfection, and early symptomatic syndromes were identified more frequently than late neurosyphilis syndromes.
Subject(s)
AIDS-Related Opportunistic Infections/epidemiology , Neurosyphilis/epidemiology , AIDS-Related Opportunistic Infections/microbiology , Adult , Age Factors , Aged , Cardiolipins/blood , Cardiolipins/cerebrospinal fluid , Cholesterol/blood , Cholesterol/cerebrospinal fluid , Female , Follow-Up Studies , Humans , Male , Middle Aged , Nervous System Diseases/diagnosis , Nervous System Diseases/epidemiology , Neurosyphilis/diagnosis , Neurosyphilis/ethnology , Phosphatidylcholines/blood , Phosphatidylcholines/cerebrospinal fluid , Retrospective Studies , San Francisco/epidemiology , Sex FactorsSubject(s)
Infections/mortality , Cause of Death , Death Certificates , Female , Humans , Male , United StatesABSTRACT
Restriction fragment length polymorphism (RFLP) and plasmid analyses were used to evaluate an outbreak of Haemophilus ducreyi in San Francisco. Fifty-four cases of culture-confirmed chancroid occurred between May 1989 and May 1991. Of these, 46 (96%) were in men and 35 (65%) were in blacks; the median age of patients was 34 years. Among the 32 isolates submitted for RFLP and plasmid analyses, six different HindIII RFLP patterns were identified. Two RFLP types were found in patients who had recently traveled to Los Angeles, Korea, or El Salvador. Four RFLP types appeared to be acquired locally and were more common among blacks (P = .002), in patients with a history of a sexually transmitted disease (P = .01), and in those who used drugs or exchanged drugs or money for sex (P = .08). The use of RFLP analysis confirmed that this outbreak was associated with multiple strains of H. ducreyi and allowed for the identification of risk factors for locally acquired chancroid.