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Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.
The Response of Symptomatic Neurosyphilis to High-Dose Intravenous Penicillin G in Patients with Human Immunodeficiency Virus Infection
New England Journal of Medicine (12/01/94) Vol. 331, No. 22, P. 1469 Gordon, Steven M.; Eaton, Molly E.; George, Rob et al
To determine whether HIV infection affects the course of syphilis and the response to treatment, researchers studied the response to treatment with high-dose penicillin G benzathine in 11 HIV-positive participants with symptomatic neurosyphilis. The patients were intravenously administered 18 million to 24 million units of penicillin G benzathine daily. The researchers found that after 24 weeks, four of the seven patients studied had decreased serum titers on rapid plasma reagin (RPR) testing by at least two doubling dilutions, and four patients had reductions in the cerebrospinal fluid titers on Venereal Disease Research Laboratory (VDRL) testing or reverted to nonreactive results. There was no normalization or improvement in serum titers on RPR testing or cerebrospinal fluid titers on VDRL testing, cell counts, or protein concentrations in two patients. Six months after treatment, one patient relapsed with meningovascular syphilis. Although T. pallidum was detected in three of 10 patients before treatment, it was not found in any of the 10 post-treatment specimens. Gordon et al concluded that therapy may fail and neurosyphilis may develop in HIV-infected patients with early syphilis. The high-dose penicillin recommended for neurosyphilis is not consistently effective in HIV-positive patients.
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Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.
