Johanna completed her medical degree at the University of Adelaide and a Masters of Public Health through Flinders University. She was based in Darwin, Australia for her basic physician training and is now an advanced trainee in general medicine at the Whangarei Hospital in New Zealand. Johanna hopes to combine a career in general medicine with dual training in public health.
Neurosyphilis: A Clinical Guideline For Diagnosis And Management
To explore the epidemiologic, diagnostic and treatment complexities of neurosyphilis in the Northern Territory of Australia and produce a guideline for clinical practice.
A systematic search was undertaken using PubMed, Scopus and Web of Science databases. Local and global neurosyphilis guidelines were also reviewed. 91 articles were identified that met inclusion criteria. 5 key themes were developed relating to neurosyphilis: (1) history and epidemiology; (2) diagnosis; (3) treatment; (4) follow up and (5) reporting. The search was refined to 34 papers, following exclusion of articles providing no new information relating to the key themes. Accepted articles underwent critical review and synthesis. A team of multidisciplinary experts was consulted during guideline formation.
High levels of treponemal infection have been observed in Northern Australia since the 1930s (Hackett 1963). In the context of a current syphilis outbreak (Kirby Institute 2018), a future rise in the incidence of neurosyphilis is anticipated. Establishing a diagnosis of neurosyphilis is complex and requires stepwise evaluation of clinical, laboratory and radiological findings (Public Health Laboratory Network 2017). Clinical practice guidelines for neurosyphilis in Australia and New Zealand are lacking.
A consensus guideline is proposed for the diagnosis and management of neurosyphilis in the Northern Territory, with applications relevant to New Zealand clinicians.
Hackett, CJ 1963, ‘On the Origin of Human Treponematoses (Pinta, Yaws, Endemic Syphilis and Venereal Syphilis)’, Bull World Health Organ, vol. 29, pp. 7-41.
Kirby Institute 2018, HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2018, https://kirby.unsw.edu.au/report/hiv-viral-hepatitis-and-sexually-transmissible-infections-australia-annual-surveillance
Public Health Laboratory Network 2017, Syphilis Laboratory Case Definition (LCD), http://www.health.gov.au/internet/main/publishing.nsf/content/cda-phln-syphilis.ht