Effect of screening for syphilis on the management of patients with cerebrovascular disease

Although meningovascular syphilis may result in cerebral ischemia, the effect of syphilis screening on the management of patients with ischemic stroke is unclear. This is due to the variability in syphilis incidence and prevalence, as well as the diverse manifestations that vary with stage of infection. We prospectively screened patients with cerebrovascular disease (CVD) for syphilis and analyzed seropositivity rates as well as assessed the impact of screening on patient management. There were relatively high rates of seropositivity in both CVD (12.5%, n = 104) and control (9.9%, n = 211) populations without a significant difference between groups. Overall, syphilis screening had little impact on the management of the patients with CVD. No cerebral event was attributed to meningovascular syphilis, and there was no identifiable group in which syphilis screening was more likely to result in treatment for meningovascular syphilis, although there were significantly (p < 0.001) higher rates of seropositivity in black patients than whites. The relatively high incidence of seropositivity in both groups is representative of local syphilis prevalence and suggests that screening is warranted in patients with neurological disease, but not necessarily as part of the evaluation for cerebral ischemia.