Diagnosis and Treatment of Neurosyphilis Complicated by Implicit Clinician Bias and Unconscious Stigma: A Case Report and Literature Review

Abstract

Syphilis, a condition known as "the great imitator," is a sexually transmitted infection caused by the bacterium Treponema pallidum that can present with a myriad of symptoms, including psychiatric and neurological changes. Severe complications of syphilis are rare nowadays due to the widespread availability of antibiotics. Nonetheless, the incidence has been increasing over the past few years. We describe the case of a middle-aged man who presented with neuropsychiatric symptoms that were initially thought to be secondary to substance use and who was eventually diagnosed with neurosyphilis. A brief review of the most common features of this condition, as well as treatment options, is presented. As this patient was part of a minority group and had a history of substance misuse that delayed the diagnosis of neurosyphilis, we will also comment on stigmas, disparities, and biases in clinical settings, and some mitigation strategies that can be implemented to prevent adverse health outcomes in marginalized populations.

Keywords: bias; neurosyphilis; psychosis; stigma; substance use.