Neurosyphilis | Spectrum

Clinical Manifestations

Early Neurosyphilis

Patients with early neurosyphilis may have asymptomatic meningitis; symptomatic meningitis; or less commonly meningitis and stroke. Vision and hearing loss with or without concomitant meningitis may also be present, and ocular/otologic syphilis is treated as neurosyphilis

Late Neurosyphilis

The most common forms involve the brain and spinal cord (dementia, general paresis, and tabes dorsalis)

Note

If possible, patients allergic to penicillin should be desensitized and treated with IV penicillin

Preferred Treatment

Aqueous Penicillin G 3-4 million units IV every 4 hours for 10-14 days

OR

Penicillin G procaine 2.4 million units IM daily

PLUS

Probenecid 500 mg orally 4 times a day for 10-14 days

Alternative Treatment

Ceftriaxone 2gm IV daily for 10-14 days

Monitoring After Treatment

Clinical exam and serologic testing with a nontreponemal test (e.g. RPR). The frequency depends on the stage of the disease (early or late)

CSF monitoring may be warranted