Neurosyphilis during the AIDS Epidemic, New Orleans, 1990–1997

Neurosyphilis and the impact of HIV infection

“…Initially recognised in the pre-antibiotic era 39 and reported early in the penicillin era, 40 several more recent case studies report neurorelapse occurring in HIV-infected patients. 19,[41][42][43][44][45] While it is difficult to rule out the possibility of reinfection entirely in these case reports, it has also been hypothesised that neurorelapse may be more common in HIV-infected patients with syphilis because benzathine penicillin G, the usual treatment for uncomplicated syphilis, does not clear T. pallidum from the CNS, the eye or the inner ear 46,47 and HIV impairs cell-mediated immunity, allowing T. pallidum to persist at these sites. 41 Further systematic studies are needed to determine whether HIV co-infection truly increases the odds of neurorelapse with syphilis.…”

Central Nervous System Diseases due to Opportunistic and Coinfections

“…Several case reports document neurorelapse occurring in HIV-infected patients. 29,[35][36][37] Neurorelapse may be more common in HIV-infected patients with syphilis because benzathine penicillin G, the usual treatment for uncomplicated syphilis, does not clear T. pallidum from the CNS, the eye or the inner ear 38,39 and HIV-induced cell-mediated immunity impairs clearance of organisms that persist at these sites. 35 HIV-infected individuals may be more likely than HIVuninfected patients to fail neurosyphilis therapy based on clinical and serological criteria as well as on failure to normalize CSF abnormalities.…”