Acute psychotic presentation in syphilis-the great imitator is back

Abstract

In the late 19th and the early 20th century, general paresis of the insane, as it was known historically, or neurosyphilis was a common cause of new-onset psychosis. Symptomatic neurosyphilis was reported in 10-20% patients with syphilis (Singh & Romanowski 1999). The widespread use of penicillin resulted in a marked reduction in syphilis (Kim 1965). Towards the end of the 20th century, syphilis was considered a rare disease and its relevance in clinical training and practice in general, and in neuropsychiatric settings in particular, diminished (Ropper 2019). Unfortunately, there has been a global resurgence of syphilis over the past decade. In England, between 2010 and 2019, the number of newly diagnosed syphilis patients increased from 2646 to 7982 (Mitchell et al. 2020). A similar increase from 45844 to 115045 was observed in the USA between 2010 and 2018 (Centers for Disease Control and Prevention 2019). Despite these increasing numbers, the clinical interest in syphilis, known for its protean manifestations earning the name of the 'great imitator', remains low.