Treatment of Tertiary Syphilis — Late Neurosyphilis in Patients with Penicillin Allergy
Late neurosyphilis is a severe neurological manifestation of tertiary syphilis. When the patient has a documented penicillin allergy, the treatment pathway requires an additional preparatory step before the standard first-line antibiotic course can begin.
Clinical scenario
Late neurosyphilis encompasses meningitis, cranial nerve dysfunction, meningo-vascular syphilis (stroke, myelitis), and parenchymatous neurosyphilis — including general paresis and tabes dorsalis. This protocol applies when the patient has a history of penicillin allergy, which modifies the treatment approach compared with non-allergic patients.
Treatment approach — partial overview
The protocol begins with an approach to establish penicillin tolerance before the first-line treatment is administered. The complete regimen, its sequencing, and the full clinical decision criteria are available in the structured protocol.
Full regimen details, dosing, and alternatives available via the 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);
Desensitization to penicillin (in fact, induction of tolerance) followed by the first-line regimen
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