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Neurosyphilis

Gloria J. Klapstein, PhD Reviewed 06/2019
 


BASICS

DESCRIPTION

  • A chronic, systemic, infectious disease with any involvement of the CNS at any stage of syphilitic Treponema pallidum infection (primary, secondary, tertiary, and latent)

  • Transmitted ...

DIAGNOSIS

HISTORY

Previous sexual contact with partner with known infection, or partner with high-risk sexual behavior, maternal transmission 

PHYSICAL EXAM

  • Many neurosyphilitic patients are asymptomatic...

TREATMENT

GENERAL MEASURES

All patients with neurosyphilis should be tested for HIV. 

MEDICATION

First Line

Aqueous crystalline penicillin G 18 to 24 million U/day, administered as 3 to 4 million U IV q4h...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • T. pallidum cannot be grown in the laboratory, and there is no microbiologic test of cure.

  • Neurologic and CSF examination at 3 to 6 months and ev...

REFERENCES

1
Workowski KA, Berman S; for Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep.  2010;59(RR-12):1–110. [View Abstrac...

ADDITIONAL READING

  • Berger JR, Dean D. Neurosyphilis. Handb Clin Neurol.  2014;121:1461–1472. [View Abstract on OvidMedline]

  • Chahine LM, Khoriaty RN, Tomford WJ, et al. The changing face of neurosy...

CODES

ICD10

  • A52.3 Neurosyphilis, unspecified

  • A52.2 Asymptomatic neurosyphilis

  • A52.13 Late syphilitic meningitis

  • A52.11 Tabes dorsalis

  • A52.14 Late syphilitic encephalitis

  • A52.17 General paresis

  • A52.10 Symptom...

CLINICAL PEARLS

  • CNS involvement can occur at any stage of syphilis infection.

  • Procaine penicillin is the gold standard for treatment. Penicillin G benzathine does not reach detectable levels in the CSF...

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