E-Pearl of the Week: Neurosyphilis in HIV patients

December 12, 2012


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December 12, 2012

Neurosyphilis in HIV patients

Neurosyphilis is on the rise again because of the AIDS epidemic. For example, in California, there was a >700% increase in primary and secondary syphilis cases reported between 1999 and 2005. Approximately one–third of patients with early syphilis have invasion of treponemes in the CSF, regardless of their HIV status. However, in contrast to patients without HIV, where neurosyphilis becomes symptomatic in the secondary or tertiary stage, most of the new cases of clinical neurosyphilis in HIV–infected individuals are identified at the initial presentation. Neurosyphilis in HIV patients has a wide presentation ranging from meningitis or encephalitis to CNS vasculitis. Neurosyphillis should be suspected in HIV patients when CD4 is less than 350 and RPR equal or higher than 1:32.


  1. Zetola NM, Klausner JD. Syphilis and HIV infection: an update. Clin Infect Dis 2007; 44: 1222–1228.
  2. Marra CM, Maxwell CL, Smith S et al. Cerebrospinal fluid abnormalities in patients with syphilis: association with clinical and laboratory features. J Infect Dis 2004; 189: 369–376.

Submitted by Chafic Karam, MD

Disclosure: Dr. Karam serves on the editorial team for the Neurology® Resident and Fellow Section.

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