A52.1 + (G01*)
DIAGNOSIS
Lumbar puncture typically shows lymphocytosis with mildly elevated protein and low/normal glucose.
Serum syphilis serology: a negative TPHA or TPAb excludes the diagnosis; RPR may be negative in some cases.
CSF syphilis serology: a CSF VDRL positive result is highly specific for neurosyphilis, but may be negative in approximately 50%; a negative CSF FTA-ABS excludes the diagnosis of neurosyphilis.
MEDICINE TREATMENT
- Benzylpenicillin (penicillin G), IV, 20 MU daily in 4–6 divided doses for 10 days.
A serum RPR response (4-fold decline in titre) after 6 months is predictive of treatment success for neurosyphilis.
Severe penicillin allergy: (Z88.0)
Refer for consideration of desensitisation and subsequent treatment with benzylpenicillin at a referral centre.