Penicillin concentrations in serum and cerebrospinal fluid after intramuscular injection of aqueous procaine penicillin 0.6 MU with and without probenecid.

Goh, B T; Smith, Geof W.; Samarasinghe, L; Singh, Vaidhvi; Lim, Khoon S.

doi:10.1136/sti.60.6.371

Cited by 16 publications

(14 citation statements)

References 6 publications

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“…This finding is consistent with the minuscule levels of penicillin that are present in the central nervous system after benzathine penicillin therapy (31). The rarity of neurosyphilis before 1980 argues that, in practice, recommended doses of penicillin were remarkably successful in curing syphilis, and it seems highly likely, in retrospect, that the relapses occurred in persons who had unrecognized HIV infection, especially when the actual case reports are read closely.…”

Section: Treatmentsupporting

confidence: 69%

Secondary Syphilitic Lesions

2005

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An important theme that emerges from all early historical accounts is that in addition to the decreased virulence of Treponema pallidum, the incidence of secondary syphilis has decreased drastically over the past three centuries. Even in the early 20th century, most syphilologists were of the opinion that the disease had undergone changes in its manifestations and that they were dealing with an attenuated form of the spirochete. Such opinions were based primarily on the observations that violent cutaneous reactions and fatalities associated with the secondary stage had become extremely rare. The rate of primary and secondary syphilis in the United States increased in 2002 for the second consecutive year. After a decade-long decline that led to an all-time low in 2000, the recent trend is attributable, to a large extent, by a increase in reported syphilis cases among men, particularly homosexual and bisexual men having sex with men. The present review addresses the clinical and diagnostic criteria for the recognition of secondary syphilis, the clinical course and manifestations of the disease if allowed to proceed past the primary stage of disease in untreated individuals, and the treatment for this stage of the disease

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Section: Treatmentsupporting

confidence: 69%

Secondary Syphilitic Lesions

2005

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“…In case 2 of our present study, however, it is possible that the three-times-a-day regime might have been insufficient, causing a nonresponse to therapy. Importantly, penicillin concentrations of more than 0.018 mg/l in CSF must be reached to effectively treat T. pallidum in the CNS [3], and some reports suggest that intramuscular administration of procaine penicillin (up to 14.4 million units) in combination with oral probenecid does not lead to effective CSF penicillin levels [1,[43][44][45]. In the UK, the treatment of neurosyphilis with intramuscular procaine penicillin combined with oral probenecid is still the gold standard and treatment failures have rarely been documented [3].…”

Section: Discussionmentioning

confidence: 99%

Late-stage neurosyphilis presenting with severe neuropsychiatric deficits: diagnosis, therapy, and course of three patients

et al. 2011

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Neurosyphilis is an infectious disease that has reappeared over the past two decades. It is caused by Treponema pallidum subspecies pallidum that can affect the central nervous system (CNS) during any stage of the disease. Besides early CNS involvement predominantly presenting with symptoms of meningitis, a parenchymal affection of the brain leading to severe neuropsychiatric symptoms particularly emerges at later stages, but is rarely seen nowadays due to early antibiotic treatment. Together with the clinical findings, a characteristic combination of serological and cerebrospinal fluid (CSF) abnormalities leads to the diagnosis of neurosyphilis and is required to assess its activity. However, particularly at later stages of disease and after antibiotic treatment, serological and CSF abnormalities may become ambiguous and, therefore, difficult to interpret. This can be accompanied by persisting or fluctuating neuropsychological deficits. To this day, no well-controlled clinical data exists concerning the treatment of late-stage neurosyphilis, neither on type, optimal dosage, duration, and long-term efficacy of antibiotic therapy. Therefore, treatment and follow-up of late-stage neurosyphilis are challenging tasks. Here, we present three cases of neurosyphilis with severe neuropsychiatric symptoms in non-immunocompromised patients and a review of the recent literature.

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“…Uwagi ogólne [63][64][65][66][67][68][69] • Należy dążyć do osiągnięcia krętkobójczego stę-żenia penicyliny w surowicy, a w przypadku kiły OUN -także w PMR. Za krętkobójcze uznaje się stężenie powyżej 0,018 mg/l, ale jest to wartość znacznie niższa niż maksymalne skuteczne stęże-nie in vitro (0,36 mg/l).…”

Section: Badania W Celu Rozpoznania Kiły Narządu Słuchuunclassified

2014 European guideline on the management of syphilis

Janier¹,

Hegyi²,

Dupin³

et al. 2015

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Penicillin concentrations in serum and cerebrospinal fluid after intramuscular injection of aqueous procaine penicillin 0.6 MU with and without probenecid.

Cited by 16 publications

References 6 publications

Secondary Syphilitic Lesions

Secondary Syphilitic Lesions

Late-stage neurosyphilis presenting with severe neuropsychiatric deficits: diagnosis, therapy, and course of three patients

2014 European guideline on the management of syphilis

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