Neurosyphilis is a symptom of the tertiary stages of syphilis (a chronic systemic infection of Treponema pallidum subspecies pallidum). Classical neurosyphilis has become a rare condition in Western countries because of the use of penicillin for the treatment of early or latent syphilis. Although textbook neuro syphilis is now uncommon, modified neuro syphilis as a consequence of intercurrent antibiotic use for other conditions may be more common. This latter condition is harder to diagnose than classical neurosyphilis because of atypical clinical and cerebrospinal fluid (CSF) findings. The coexistence of HIV infection and syphilis has further complicated the picture.
There have been no well controlled trials of treatments for neurosyphilis. Nevertheless, the treatment of choice for established neurosyphilis has been shown to be benzylpenicillin (penicillin G). The drug is administered as an intensive therapy of frequent intravenous high doses or high doses of an intramuscular repository formulation with probenecid. Other agents that can be used include high dose amoxicillin (amoxycillin) with probenecid (but compliance cannot be monitored), tetracyclines, macrolides or ceftriaxone. If the individual is HIV-positive or of unknown serostatus, benzylpenicillin should be used to prevent or treat neurosyphilis. In patients who are allergie to penicillin, rush desensitisation can be used to allow administration of benzylpenicillin. Alternatively, non-penicillin antibiotics can be used.
Much work has been performed to establish the bactericidal concentrations of penicillin and other antibiotics in serum and CSF. However, the significance of these values is uncertain because the causative pathology of neurosyphilis may lie in the perivascular space.
Follow-up and counselling of patients with neurosyphilis, and repeat lumbar puncture for analysis of CSF where initially abnormal, are recommended.
Adis International Limited Syphilis Probenecid Penicillin Allergy Meptazinol
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