Neurosyphilis in 2025

PURPOSE OF REVIEW: Syphilis continues to be a major global health problem. In recent years epidemics of syphilis have also been reported in many high-income countries. In this review, we aim to highlight varied presentations, including recent guidelines on diagnosis and treatment, including in people with HIV (PWH). RECENT FINDINGS: Neurosyphilis is increasingly being diagnosed and presentations are varied in both the immunocompetent and immunocompromised host. An appropriate history, examination and diagnostic work-up is central to identification of neurosyphilis and to enable appropriate treatment. Clear criteria for indication and interpretation of results from lumbar punctures, neuroimaging and treatment protocols have been outlined by the British association for sexual health and HIV (BASHH) in 2024. SUMMARY: The increase in overall cases of syphilis has been accompanied by increases in the number of cases with neurological involvement. The presentation of neurosyphilis is variable and may occur early or late in the disease course. It is important to be aware of the varied presentations, diagnostic and treatment criteria to limit the late sequelae of disease and address the global health challenge it poses and measures being taken to help reduce this global burden

Adolescent mental, sexual and reproductive health in Ghana: a stakeholder analysis of actors' influence over policy formulation and implementation

One in five adolescents (10-19) live in sub-Saharan Africa. Despite the availability of policies targeted at this age group, policy formulation, implementation, and gains in adolescent health continue to be underwhelming. Actors or stakeholders are architects of policy, bringing their ideological values, interests, power, and positions to policy formulation and implementation and thus influencing the policy process. We analysed multi-level stakeholder interests, positions, power and their influence on adolescent sexual, reproductive and mental health policy formulation and implementation in Ghana, West Africa, using a single-case study design with multiple embedded sub-units of analysis. The case was defined as actors, their power, interests, positions, and the influence on policy formulation and implementation processes in adolescent sexual, reproductive and mental health. A conceptual framework of conflict and synergies between stakeholder interests, power, and positions and the influence on policy formulation and implementation was used to guide the analysis. Data was obtained from key informant in-depth interviews with 18 global and national level and 16 sub-national level stakeholders; 4 focus group discussions with district health management teams, 9 with frontline health workers and 20 with in and out of school adolescents in four districts in the Greater Accra region of Ghana. The multiple stakeholders in adolescent health, including adolescents themselves, had sometimes synergistic and sometimes divergent and conflicting views on policy agendas, formulation and approaches to implementation. Unresolved conflicts between powerful stakeholders in the public or bureaucratic arena stalled or hampered policy formulation and implementation, whereas consensus and adequate resourcing moved processes forward. It is important to invest effort in understanding actors, their power, positions and interests in context to inform policy content and framing to increase the chances of consensus and effective policy formulation and implementation processes

Is Checking for Sequential Positivity Violations Getting You Down? Try sPoRT!

BACKGROUND: Sequential positivity is often a necessary assumption for drawing causal inferences, such as through marginal structural modeling. Unfortunately, verification of this assumption can be challenging because it usually relies on multiple parametric propensity score models, unlikely to all be correctly specified. Therefore, we propose a new algorithm, called sequential Positivity Regression Tree (sPoRT), to overcome this issue and identify the subgroups found to be violating this assumption, allowing for insights about the nature of the violations and potential solutions. METHODS: We present different versions of sPoRT based on either stratifying or pooling over time under static or dynamic treatment strategies. This methodologic development was motivated by a real-life application of the impact of the timing of initiation of HIV treatment with and without smoothing over time, which we also use to demonstrate the method. RESULTS: The illustration of sPoRT demonstrates its easy use and the interpretability of the results for applied epidemiologists. Furthermore, an R notebook showing how to use sPoRT in practice is available at github.com/ArthurChatton/sPoRT-notebook. CONCLUSIONS: The sPoRT algorithm provides interpretable subgroups violating the sequential positivity violation, allowing patterns and trends in the confounders to be easily identified. We finally provided practical implications and recommendations when positivity violations are identified

Effect of a novel house design (star home) on indoor malaria mosquito abundance in rural Tanzania: secondary outcomes of an open-label, household, randomised controlled trial.

BACKGROUND: Screening houses can reduce malaria transmission in sub-Saharan Africa. Our study evaluated whether a novel screened house design (star home) with bedrooms on the second storey reduced indoor mosquito abundance compared with traditional houses in Mtwara, Tanzania. METHODS: In this open-label, household, randomised controlled trial, indoor mosquito abundance was assessed in 110 star homes and 110 neighbouring traditional houses in 59 villages from Jan 5, 2022, to Dec 20, 2023. Mosquitoes were collected using US Centers for Disease Control light traps every 7 weeks. Anopheles gambiae and Anopheles funestus species were identified using PCR and Plasmodium falciparum sporozoites detected using ELISA. Nightly temperature, CO2 concentrations, and duration of door opening was recorded. Differences between study groups were analysed using generalised linear mixed-effects models. The trial is registered with ClinicalTrials.gov (NCT04529434). FINDINGS: Of 9290 mosquitoes collected, 1899 were A gambiae, 69 were A funestus, and 7322 Culex species, mainly Culex quinquefasciatus. Star homes had 51% less A gambiae (adjusted risk ratio [RR] 0·49, 95% CI 0·35 to 0·69; p<0·0001) and 61% less Culex species (RR 0·39, 0·32 to 0·48; p<0·0001) than traditional houses. At night, star homes were 0·5°C cooler (95% CI 0·2 to 0·9; p=0·010), with similar concentrations of CO2 (-7 ppm, 95% CI -19 to 6; p=0·285) and had external doors open 53% less time than traditional houses (7·5 min/h vs 16·2 min/h; p<0·0001). INTERPRETATION: Star homes reduced indoor mosquito abundance and malaria transmission risk compared with traditional houses, demonstrating the protective efficacy of houses that are well screened and air permeable in rural Africa. FUNDING: Hanako Foundation, Singapore

Harnessing artificial intelligence to address diseases attributable to unsafe drinking water: challenges, potentials, and recommendations

Unsafe drinking water is a global concern that poses serious risks to public health, especially in developing nations, where tainted water can spread diseases such as cholera, polio, and diarrhea, which can result in several health issues and deaths. Children and immunocompromised people are the most vulnerable groups that suffer disproportionately from waterborne illnesses. Promising approaches to reduce the burden of waterborne diseases and revolutionize drinking water management are provided by artificial intelligence (AI). Public health authorities and water industries can improve safe drinking water distribution, treatment, and monitoring using AI-powered models and approaches. AI enables predictive modeling to support sustainable water management techniques, maximize resource usage, and identify problems with infrastructure and water quality earlier. AI, coupled with Geographic Information Systems (GIS) and machine learning (ML) models such as random forest classifiers, aids in cholera risk prediction and enhances waterborne disease detection. Advanced AI models facilitate drought forecasting, reservoir optimization, and real-time water monitoring, improving water management and resource conservation. AI-driven systems, including predictive analytics and intelligent water distribution models, show potential for enhancing water safety, mitigating risks, and promoting sustainable water practices. However, several challenges must be overcome when incorporating AI into water management, such as concerns about data quality, infrastructure constraints, and ethical difficulties. Genetic sequencing and metagenomic analyses, which provide insights into microbial dynamics and water quality maintenance, are potential future areas in AI applications for water management. A balanced approach prioritizing equitable deployment, infrastructure readiness, workforce development, robust governance, collaborative efforts, ethical standards, and transparent regulatory frameworks, ensuring social equity and economic efficiency with current norms and policies, is required for AI integration to address diseases attributable to unsafe drinking water. These AI models are expedient to fully optimize WASH disease management to increase access to clean water, reduce the incidence of waterborne diseases, and advance global health

Meeting Report on an Integrated Research Agenda for Mosquito-Borne Arboviruses.

The emergence and re-emergence of mosquito-borne arbovirus (MBV) diseases pose a rapidly expanding global health threat fueled by the convergence of multiple ecologic, economic, and social factors, including climate change, land use, poverty, deficiencies of water storage and sanitation, and limitations of vector control programs. On December 6, 2023, the Wellcome Trust and the University of Minnesota's Center for Infectious Disease Research and Policy held a meeting titled "An integrated approach to mosquito-borne arboviruses: a priority research agenda." The meeting comprised presentations, panels, and facilitated discussions aimed at describing the state of the field, highlighting recent accomplishments, identifying novel strategies, and defining priority research goals and approaches for addressing MBV disease preparedness and response. This report summarizes meeting discussions in 3 key areas: the changing epidemiology of MBV disease, current and potential transmission- and disease-monitoring strategies, and evolutionary impacts on disease burden and transmission. It concludes with a list of priority strategies for research and investment in MBV disease prevention, preparedness, and control. To prepare for future epidemics of MBV diseases, research and policy will benefit from a multipathogen approach to MBVs. Building on existing knowledge and systems, these efforts must address social and ecological factors and connect with other global health agendas

First referral hospitals in low-resource settings: a narrative review of expectations for clinical service provision.

First referral hospitals (FRHs) have an important role to play in helping many countries achieve 'Health for All'. However, their specific role and the clinical services they are expected to provide to achieve this are evolving. To explore this issue further, we undertook a narrative review to examine the clinical service expectations of FRHs outlined in academic and policy literature, which identified a total of 404 FRH service expectations. At a global level, some categories of services provide extensive specific service recommendations, likely resulting from historical priorities and the influence of vertical programming and professional interests. However, in several important areas we identified few or no recommendations. At the level of individual country case studies undertaken through this review, FRH clinical service recommendations within available policy documents vary considerably. Our findings suggest a disconnect between the ambition for FRH and the difficult, context-specific decision-making needed at the national level on the role of FRHs as a service delivery platform within integrated health systems helping countries achieve universal health coverage

Hybrid, vaccine-induced and natural immunity against SARS-CoV-2 in traditional food markets in Bolivia (2020-2022): A cross-sectional analysis of a serological survey.

BACKGROUND: In low-and middle-income countries, market vendors played a crucial role in food security during the coronavirus pandemic. High numbers of contacts, combined with social, political and health system upheaval in Bolivia, meant they were highly exposed to SARS-CoV-2 infections. METHODS: Demographic, clinical and serological data were collected at survey rounds between 2020 and 2022 from a cohort of market vendors in two purposively selected markets where the community and researchers co-promoted health and safety. We used these longitudinal data to examine SARS-CoV-2 anti-spike antibody levels between those vaccinated with and without previous infection and those unvaccinated. The association between antibody levels, and vaccine status, socio-demographic and health information was assessed using linear regression. FINDINGS: A total of 213 market vendors had repeated serological sampling in July, and November 2021, and again in May 2022. In November 2020, 105 (49.3 %) of this cohort had participated in a pre-vaccination municipal serological survey. Seroprevalence then was 45·7 % (95 %CI 36·3-55·4). By November 2021, 67·8 % of the full cohort had one vaccination and seroprevalence was 83·6 %. We showed IgG levels in those seropositive were higher in participants with evidence of vaccination and prior infection compared to those unvaccinated. By May 2022, the majority of participants developed antibodies against SARS-CoV-2, and these differences were attenuated. INTERPRETATION: A substantial proportion of vendors were susceptible to SARS-CoV-2 in late 2020 when, nationally, excess mortality was high. Our analyses suggested a combination of natural infection and vaccination provided better protective antibody levels than natural infection alone at the peak of the pandemic. Future pandemic planning requires timely targeted serological surveys to understand pandemic dynamics and support prompt interventions. In addition, communication with organized communities can inform effectiveness of pandemic mitigation strategies including improved vaccination uptake. Timely quantitative IgG level monitoring can also inform waning immunity. FUNDING: This study was supported by the Medical Research Council and a National Institutes for Health and Care Research (NIHR) Global Effort on COVID-19 (GECO) Health Research award 2020 [MR/V028561/1]

Description of four cases of male genital schistosomiasis (MGS) in children and adolescents, with a scoping review.

We present four cases of male genital schistosomiasis (MGS) within children and adolescents opportunistically encountered as part of a wider screening programme for imported schistosomiasis in Germany and community outreach screening in Mali. Such genital manifestations in young children and adolescents are often overlooked but can include hydrocele, hypogonadism, varicocele, cutaneous granulomata on the penis and scrotum, echogenic spots in the prostate and the epididymis, alongside testicular masses. Though these cases appear sporadic, from our scoping literature review, they draw fresh attention on MGS in young children and highlight wider confusion with other congenital, neoplastic and infectious disease. These might include an insufficient closure of the tunica vaginalis, malignancies or lymphatic filariasis. Frequently haematuria is not present. One typical sign indicating MGS in adults, i.e. haematospermia is not present before puberty. Another reason of missing MGS cases may be that screening with scrotal or transabdominal ultrasonography are not easily accepted unless the reason for it is not extensively explained beforehand and that transabdominal ultrasonography is less sensitive for revealing prostatic lesions than transrectal ultrasonography

The Use of Pictorial Recall Aids Modifies Dietary Assessment Results: Experiences from Quantitative 24-hour Dietary Recalls of Young Children in Nepal and Senegal.

BACKGROUND: Recall bias or memory error is a known limitation of recall-based dietary assessment methods and can lead to substantial misrepresentation of diets. Pictorial recall aids have been used by various studies to mitigate recall bias, but their effect on quantitative, 4-pass 24-h dietary recall (24HR) results has not yet been measured. OBJECTIVES: This article examines uptake of pictorial recall aids among caregivers of young children in Kathmandu Valley, Nepal, and Guédiawaye Department, Senegal; describes what foods/beverages are subject to recall bias in these contexts; and assesses the effect of these recall aids on estimated dietary outcomes. METHODS: We used cross-sectional data from 24HR surveys that provided a recall aid to reduce caregiver recall bias. Young children's dietary outcomes were calculated from the 24HR data. Logistic regressions were used to compare characteristics and estimated dietary outcomes of children by recall aid uptake. McNemar's test and paired t-tests were used to compare estimated dietary outcomes in initial 24HR data with revised 24HR data that incorporated omitted items identified by the recall aid. RESULTS: Pictorial recall aids had relatively high uptake by caregivers in both contexts. Beverages, unhealthy snacks, and fruit were most subject to recall bias. Adding omitted items identified by recall aids resulted in statistically significant changes in most dietary outcomes assessed. Children of caregivers who chose to use the recall aid had significantly different estimated dietary outcomes than children of caregivers who did not use the recall aid. CONCLUSIONS: The use of pictorial recall aids modifies 24HR results in these 2 contexts. Rigorous research is needed to fully understand the impact of recall aids on 24HR methodology and results, with an aim to improve the accuracy of dietary assessment and ultimately inform evidence-based nutrition programming, policy, and recommendations