Neurosyphilis

Summary

Syphilis is an old disease and its incidence in developed countries decreased in the second half of the last century. However, at present, syphilis is on increase again. Since 1990, when the incidence was lowest, the incidence of syphilis in the Czech Republic increased more than six-fold with HIV+ homosexual men and drug addicts being the highest risk groups. The CNS can be involved at any stage of syphilis; early forms of neurosyphilis currently predominate, whereas late complications rarely occur. The diagnosis of syphilis is based on serological tests. A combination of both nonspecific (nontreponemal) and specific (treponemal) methods are used for screening; specific tests are used for confirmation. Clinical sympto­matology of neurosyphilis is very variable and comprehensive analysis of cerebrospinal fluid including specific and nonspecific serologic tests plays a crucial role in diagnostics. Legislation requires all cases of diagnosed syphilis to be reported and treated. Neurosyphilis is treated with benzylpenicillin as a standard, other antibiotics are less effective. After completing the therapy, all patients are followed up long-term by a venereologist. Considering the complex clinical and laboratory symptomatology of neurosyphilis, correct diagnosis and optimal therapeutic decision requires close cooperation between a neurologist, venereologist and laboratory specialist.

Key words:
syphilis – neurosyphilis – diagnosis – therapy