Neurosyphilis: How Do You Know, and What Do You Do?

About 8 years ago, Hector was diagnosed with and treated for syphilis. Two years later, he presented with fever and a diffuse papulosquamous eruption after an unprotected sexual contact. His RPR rose to 1:128. He was treated for presumed secondary syphilis. His symptoms resolved, but he began to complain of more frequent headaches. Two years ago, he again developed fever, and papulosquamous eruption localized to his left arm; his RPR rose to 1:128. He was treated again for secondary syphilis. During the past year, Hector's RPR has remained quite elevated, and he still has frequent severe headaches.

Hector is a 43-year-old gay man who has been HIV-positive for at least 10 years. His only AIDS-related infection has been a single, self-limited episode of cryptosporidial diarrhea. On various antiretroviral regimens, his CD4 count has ranged from 150 to 250 cells/mm³, and his viral load has generally remained less than 5000 copies/mL. Other than a mild peripheral neuropathy in his feet and occasional migraine headaches, he has been well. He takes combination antiretrovirals fairly reliably, and he periodically uses intramuscular decadurabolin, topical testosterone, or both.

At his first medical visit about 8 years ago, Hector had a reactive rapid plasma reagin (RPR) test at a dilution of 1:8 and a positive fluorescent treponemal antibody ab…

Authors

Keith Henry, MD

Joseph I. Harwell, MD

Neurosyphilis: How Do You Know, and What Do You Do?

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