{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T13:43:40Z","timestamp":1792417420816,"version":"4.4.0"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Syphilis can involve the central nervous system at any stage; however, routine cerebrospinal fluid (CSF) examination is rarely performed in neurologically asymptomatic patients with secondary syphilis. We describe a case series of eight male patients with secondary syphilis and high serum venereal disease research laboratory (VDRL) titers (\u22651:16) evaluated at a tertiary teaching hospital in western Maharashtra, India (2024\u20132025). Five patients were human immunodeficiency virus (HIV)-positive and on antiretroviral therapy. None had neurological symptoms or signs; however, all had CSF abnormalities, consistent with asymptomatic neurosyphilis, including reactive CSF\u2013VDRL in all patients, with mild pleocytosis and\/or elevated protein in some. All patients received intravenous aqueous crystalline penicillin G for 14 days, with a serological response observed in most follow-up cases. These findings suggest that high titers in secondary syphilis, particularly in the presence of HIV co-infection and behavioral risk factors, may warrant consideration of CSF evaluation even in the absence of neurological manifestations.<\/jats:p>","DOI":"10.4103\/aian.aian_52_26","type":"journal-article","created":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T17:00:19Z","timestamp":1778950819000},"page":"446-448","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["High Titers, Hidden Disease: Asymptomatic Neurosyphilis in Secondary Syphilis \u2013 A Case Series from Western Maharashtra"],"prefix":"10.4103","volume":"29","author":[{"given":"Viren A","family":"Rohra","sequence":"first","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, B. J. Government Medical College and Sassoon General Hospital, Maharashtra University of Health Sciences, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiran J","family":"Dange","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, B. J. Government Medical College and Sassoon General Hospital, Maharashtra University of Health Sciences, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shekhar Nana","family":"Pradhan","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, B. J. Government Medical College and Sassoon General Hospital, Maharashtra University of Health Sciences, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasudha A","family":"Belgaumkar","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, B. J. Government Medical College and Sassoon General Hospital, Maharashtra University of Health Sciences, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neelam K","family":"Bhat","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, B. J. Government Medical College and Sassoon General Hospital, Maharashtra University of Health Sciences, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suraj","family":"Wani","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, B. J. 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