Compared with the general population, researchers found that the incidence of syphilis was more than 3 times greater in patients with ESKD.
“The incidence of new cases [of the sexually transmitted infection syphilis] is increasing in the general US population, with 14.9 cases per 100,000 individuals in 2011,” Erena N. Weathers, MD, of the department of medicine at Augusta University in Georgia, and colleagues wrote. “Patients with end-stage renal disease may be at particular risk for syphilis due to the more frequent occurrence of known risk factors for the disease, including human immunodeficiency virus (HIV). Despite the presence of these comorbidities, the incidence of syphilis in the ESRD population has not been reported. It is important to appreciate the prevalence of syphilis in this group, because if detected, the disease is easily treatable.”
Using the United States Renal Data System, researchers identified 759,066 patients who initiated dialysis between 2004 and 2010. Of these, 383 were subsequently diagnosed with syphilis.
Noting that the incident rate of any syphilis diagnosis has increased every year from 2004 to 2011, researchers calculated an 8-year incidence rate of 50.45 cases per 100,000 person-years. The most common forms were unspecified syphilis (29.77 cases) and neurosyphilis (10.93 cases), the latter of which has the potential to cause “serious clinical complications, including cranial nerve dysfunction, ophthalmic disturbances and meningitis.”
Highest incidence rates occurred on the East and West coasts, which researchers hypothesized was due to the larger urban populations. It was further observed that patients who also had HIV (relative risk = 7.61), hepatitis C (HCV; RR = 3.57), herpes simplex (HSV; RR = 2.06) or hepatitis B (HBV; RR = 1.75) had an increased risk. 71% of the syphilis cases examined for the study were attributed to black patients and 25.3% of cases were attributed to white patients.
When compared with the general population, researchers found that the incidence of syphilis was 3-times greater in patients with end-stage kidney disease.
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The researchers argued that that screening for syphilis should be done when evaluating changes in mental status, which occur frequently in patients on dialysis.
“Alterations in mental status changes may be due to chronic pathologies, such as stroke or dementia, as well as more acute pathologies, such as metabolic and infectious causes,” they wrote. “Our data suggest that in confused dialysis patients, neurosyphilis should be considered, especially if there is serologic evidence of HIV, HCV, HBV or HSV. Making a diagnosis of neurosyphilis is important because, with proper antibiotic therapy, it is treatable.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.