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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Goldmeier D, Hay P. A review and update on adult syphilis, with particular reference to its treatment. Int J STD AIDS 1993; 4: 70–82PubMedGoogle Scholar
Marra CM, Slatter V, Tartaglione TA, et al. Evaluation of aqueous penicillin G and ceftriaxone for experimental neurosyphilis. J Infect Dis 1992; 165: 396–7PubMedCrossRefGoogle Scholar
Lukehart SA, Hook III EW, Baker-Zander SA, et al. Invasion of the central nervous system by Treponema pallidum: implications for diagnosis and treatment. Ann Intern Med 1988; 109: 855–62PubMedGoogle Scholar
Luger A, Schmidt BL, Steyrer K, et al. Diagnosis of neurosyphilis by examination of the cerebrospinal fluid. Br J Vener Dis 1981; 57: 232–7PubMedGoogle Scholar
Muller F, Moskophidis M. Estimation of the local production of antibodies to Treponema pallidum in the central nervous system of patients with neurosyphilis. Br J Vener Dis 1983; 59: 80–4PubMedGoogle Scholar
Stamm LV, Stapleton JT, Bassford PJ. In vitro assay to demonstrate high level erythromycin resistance of a clinical isolate of Treponema pallidum. Antimicrob Agents Chemother 1988; 32: 164–9PubMedCrossRefGoogle Scholar
Kramer PW, Griffiths RS, Campbell RL. Antibiotic penetration of the brain. A comparative study. J Neurosurg 1969; 31: 295–302PubMedCrossRefGoogle Scholar
Wellman WE, Dodge Jr HW, Heilman FR, et al. Concentration of antibiotics in the brain. J Clin Lab Med 1954; 43: 275–9Google Scholar
Goh BT, Smith GW, Samarasinghe L, et al. Penicillin concentrations in serum and cerebrospinal fluid after intramuscular injections of aqueous procaine penicillin 0.6 MU with and without probenecid. Br J Vener Dis 1984; 60: 371–3PubMedGoogle Scholar
Goldmeier D, Waterworth PM, Penetration of penicillin into the cerebrospinal fluid of patients with latent syphilis. Pharmotherapeutica 1981; 1: 14–7Google Scholar
Van Der Valk PFM, Kraai EJ, Von Voorster-Vader PL, et al. Penicillin concentrations in cerebrospinal fluid (CSF) during repository treatment regime for syphilis. Genitourin Med 1988; 64: 223–5PubMedGoogle Scholar
Frentz G, Neilson PB, Esperson F, et al. Penicillin concentrations in blood and spinal fluid after a single intramuscular injection of penicillin G benzathine. Eur J Clin Microbiol 1984; 3: 147–9PubMedCrossRefGoogle Scholar
Faber WR, Bos JD, Rietra PJGM, et al. Treponemacidal levels of amoxycillin in cerebro spinal fluid after oral administration. Sex Transm Dis 1983; 10: 148–50PubMedCrossRefGoogle Scholar
Whiteside Yim C, Flynn NM, Fitzgerald FT. Penetration of oral doxycycline into the cerebro spinal fluid of patients with latent or neurosyphilis. Antimicrob Agents Chemother 1985; 28: 347–8CrossRefGoogle Scholar
Sullivan TJ. Antigen specific desensitisation of patients allergic to penicillin. J Allergy Clin Immunol 1982; 69: 500–8PubMedCrossRefGoogle Scholar
Wendel GD, Stark BJ, Jamison RB, et al. Penicillin allergy and desensitisation in serious infection in pregnancy. N Engl J Med 1985; 312: 1229–32PubMedCrossRefGoogle Scholar
Fernando WL, Cerebrospinal fluid findings after treatment of early syphilis with penicillin. A further series of 80 cases. Br J Vener Dis 1968; 68: 134–5Google Scholar
Hahn RD, Cutler RC, Curtis AC, et al. Penicillin treatment of asymptomatic central nervous system syphilis. Arch Dermatol 1956; 74: 355–66CrossRefGoogle Scholar
Wiesel J, Rose DN, Silver AL, et al. Lumbar puncture in asymptomatic late syphilis. An analysis of the benefits and risks. Arch Intern Med 1985; 145: 465–8PubMedCrossRefGoogle Scholar
Hay PE, Clarke JR, Taylor-Robinson D, et al. Detection of treponemal DNA in the CSF of patients with syphilis and HIV infection using the polymerase chain reaction. Genitourin Med 1990; 66: 428–32PubMedGoogle Scholar
Tomberlin MG, Holtom PD, Owens JL, et al. Evaluation of neurosyphilis in human immunodeficiency virus - infected individuals. Clin Infect Dis 1994; 18: 288–94PubMedCrossRefGoogle Scholar
Johns DR, Tierny M, Felsenstein D. Alterations in the natural history of neurosyphilis by concurrent infection with the human immunodeficiency virus. N Engl J Med 1987; 316: 1569–72PubMedCrossRefGoogle Scholar
Berry CD, Hooton TM, Collier AC, et al. Neurological relapse after benzathine penicillin therapy for secondary syphilis in HIV infection. N Engl J Med 1987; 316: 1587–9PubMedCrossRefGoogle Scholar
Rothenburg R. Treatment of neurosyphilis. J Am Vener Dis Assoc 1976; 3: 153–8Google Scholar
Wilner E, Brody JA. Prognosis of general paresis after treatment. Lancet 1968; 11: 1370–1CrossRefGoogle Scholar
Teklu B, Habte-Michael A, Warrell D, et al. Meptazinol diminishes the Jarisch-Herxheimer reaction of relapsing fever. Lancet: 1983; I: 835–9CrossRefGoogle Scholar