Neurosyphilis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]
Neurosyphilis Among HIV-Infected Persons
Treatment
HIV-infected patients with neurosyphilis should be treated according to the recommendations for HIV-negative patients with neurosyphilis.
Special considerations
- HIV-infected, penicillin-allergic patients who have neurosyphilis should be managed according to the recommendations for penicillin-allergic, HIV-negative patients with neurosyphilis.
- Several small observational studies conducted in HIV-infected patients with neurosyphilis suggest that ceftriaxone 1-2 g IV daily for 10-14 days might be effective as an alternate agent.[1][2][3]
Follow-up
- If CSF pleocytosis was present initially, a CSF examination should be repeated every 6 months until the cell count is normal.
- Follow-up CSF examinations also can be used to gauge response after therapy.
- Limited data suggest that changes in CSF parameters might occur more slowly in HIV-infected patients, especially those with more advanced immunosuppression.[4][5]
- If the cell count has not decreased after 6 months or if the CSF is not normal after 2 years, retreatment should be considered.
Related chapters
Resources
- UCSF HIV InSite Knowledge Base Chapter: Syphilis and HIV
- "A New Gold Standard For Syphilis?" Poster Presentation for European Academy of Dermatology and Venereology 2004 Spring Symposium
- Syphilis Pictures and Information
- Kipkeepers, Pox and Gleet Vendors: A Rapid History of Syphilis
- POX: Genius, Madness, and the Mysteries of Syphilis
- Syphilis Informational resource
- Secrets of the Dead (PBS): The Syphilis Enigma
- Syphilis and AIDS: Lessons from history
- "Syphilis fact sheet" from the Center for Disease Control
- The treatment of dementia paralytica by malaria inoculation (A Nobel Prize lecture, December 13, 1927)
- National Institute of Allergy and Infectious Diseases Factsheet
- New study blames Columbus for syphilis spread from Reuters Jan 15, 2008
References
- ↑ Dowell ME, Ross PG, Musher DM, Cate TR, Baughn RE (1992) Response of latent syphilis or neurosyphilis to ceftriaxone therapy in persons infected with human immunodeficiency virus. Am J Med 93 (5):481-8. PMID: 1442850
- ↑ Smith NH, Musher DM, Huang DB, Rodriguez PS, Dowell ME, Ace W et al. (2004) Response of HIV-infected patients with asymptomatic syphilis to intensive intramuscular therapy with ceftriaxone or procaine penicillin. Int J STD AIDS 15 (5):328-32. DOI:10.1258/095646204323012823 PMID: 15117503
- ↑ Ghanem KG, Moore RD, Rompalo AM, Erbelding EJ, Zenilman JM, Gebo KA (2008) Antiretroviral therapy is associated with reduced serologic failure rates for syphilis among HIV-infected patients. Clin Infect Dis 47 (2):258-65. DOI:10.1086/589295 PMID: 18532887
- ↑ Marra CM, Maxwell CL, Tantalo L, Eaton M, Rompalo AM, Raines C et al. (2004) Normalization of cerebrospinal fluid abnormalities after neurosyphilis therapy: does HIV status matter? Clin Infect Dis 38 (7):1001-6. DOI:10.1086/382532 PMID: 15034833
- ↑ Ghanem KG, Moore RD, Rompalo AM, Erbelding EJ, Zenilman JM, Gebo KA (2008) Neurosyphilis in a clinical cohort of HIV-1-infected patients. AIDS 22 (10):1145-51. DOI:10.1097/QAD.0b013e32830184df PMID: 18525260