Treatment of Tertiary Syphilis with Late Neurosyphilis — Meningitis, Cranial Nerve Dysfunction, and Meningo-Vascular Syphilis
Late neurosyphilis is a serious neurological manifestation of tertiary syphilis, presenting across a wide spectrum of syndromes. In patients without penicillin allergy, the approach to treatment differs from other stages and requires a specific intravenous regimen.
Clinical scenario
Late neurosyphilis encompasses meningitis, cranial nerve dysfunction, meningo-vascular syphilis (stroke or myelitis), and parenchymatous neurosyphilis (general paresis or tabes dorsalis). This protocol applies specifically to patients presenting with one or more of these manifestations in the absence of penicillin allergy.
Treatment approach
Treatment is centred on intravenous benzyl penicillin administered over a defined course. The complete dosing schedule, duration, and clinical monitoring targets are set out in the full protocol.
References
DOI: 10.1111/jdv.16946
Late neurosyphilis encompasses meningitis, cranial nerve dysfunction, meningo-vascular syphilis (stroke, myelitis) and parenchymatous neurosyphilis (general paresis, tabes dorsalis);
Benzyl penicillin 18–24 million units IV daily, as 3–4 million units every 4 h for 10–14 days
View source ↗