Tx neurosyphilis ocular syphilis1 w IV aqueous crystalline penicillin G2 18 24 MU day divided 3 4 MU IV q4h or via continuous infusion x10 14 days3

¹ No single test can be used to diagnose neurosyphilis in all instances. Dx depends on combo of CSF tests in presence of reactive serologic tests and neuro s/sx. CSF-VDRL is highly specific but insensitive. In a pt w/ neuro s/sx, a reactive CSF-VDRL (in absence of blood contamination) is considered diagnostic of neurosyphilis. When CSF-VDRL is negative despite presence of clinical signs of neurosyphilis, reactive serologic test results, and abnormal CSF cell count and/or protein, neurosyphilis should be considered. In this instance, additional eval using FTA-ABS testing on CSF may be warranted. CSF FTA-ABS test is less specific for neurosyphilis than CSF-VDRL but is highly sensitive. Neurosyphilis highly unlikely w/ a negative CSF FTA-ABS, esp among pts w/ nonspecific neuro s/sx.<br><br>
² Penicillin G is the only known effective tx for preventing transmission to the fetus and for fetal infxn; if penicillin-allergic, desensitize and treat w/ penicillin.
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³Treat ocular syphilis as if neurosyphilis, even if CSF normal, and in collaboration w/ ophthalmologist.
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⁴ Placental inflammation from congenital infxn might increase risk for perinatal transmission of HIV.
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⁵ Sonographic signs of fetal/placental syphilis (ie, hepatomegaly, ascites, hydrops, fetal anemia, or a thickened placenta) indicate a greater risk for fetal tx failure; manage in consultation w/ OB. Evidence insufficient to recommend specific regimens for these situations.
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⁶ Inadequate tx in the pregnant pt is likely if delivery occurs w/in 30 days of tx, clinical signs of infxn present at delivery, or Ab titer in the pregnant pt at delivery is 4-fold higher than pre-tx titer.