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| {{Syphilis}} | | {{Syphilis}} |
| {{CMG}}; {{AOEIC}} {{LG}} | | {{CMG}}; {{AOEIC}} {{LG}} |
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| ==Neurosyphilis Among HIV-Infected Persons==
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| ====Treatment====
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| [[HIV]]-infected patients with [[neurosyphilis]] should be treated according to the recommendations for HIV-negative patients with neurosyphilis.
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| ====Special considerations====
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| *HIV-infected, [[Syphilis medical therapy#Pencillin allergy|penicillin-allergic]] patients who have [[neurosyphilis]] should be managed according to the recommendations for penicillin-allergic, HIV-negative patients with neurosyphilis.
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| *Several small observational studies conducted in HIV-infected patients with neurosyphilis suggest that [[ceftriaxone]] 1-2 g IV daily for 10-14 days might be effective as an alternate agent.<ref name="pmid1442850">Dowell ME, Ross PG, Musher DM, Cate TR, Baughn RE (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1442850 Response of latent syphilis or neurosyphilis to ceftriaxone therapy in persons infected with human immunodeficiency virus.] ''Am J Med'' 93 (5):481-8. PMID: [http://pubmed.gov/1442850 1442850]</ref><ref name="pmid15117503">Smith NH, Musher DM, Huang DB, Rodriguez PS, Dowell ME, Ace W et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15117503 Response of HIV-infected patients with asymptomatic syphilis to intensive intramuscular therapy with ceftriaxone or procaine penicillin.] ''Int J STD AIDS'' 15 (5):328-32. [http://dx.doi.org/10.1258/095646204323012823 DOI:10.1258/095646204323012823] PMID: [http://pubmed.gov/15117503 15117503]</ref><ref name="pmid18532887">Ghanem KG, Moore RD, Rompalo AM, Erbelding EJ, Zenilman JM, Gebo KA (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18532887 Antiretroviral therapy is associated with reduced serologic failure rates for syphilis among HIV-infected patients.] ''Clin Infect Dis'' 47 (2):258-65. [http://dx.doi.org/10.1086/589295 DOI:10.1086/589295] PMID: [http://pubmed.gov/18532887 18532887]</ref>
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| ====Follow-up====
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| *If [[Lumbar puncture#Diagnostics|CSF pleocytosis]] was present initially, a [[Syphilis laboratory tests#CSF analysis|CSF examination]] should be repeated every 6 months until the cell count is normal.
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| *Follow-up CSF examinations also can be used to gauge response after therapy.
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| *Limited data suggest that changes in CSF parameters might occur more slowly in HIV-infected patients, especially those with more advanced immunosuppression.<ref name="pmid15034833">Marra CM, Maxwell CL, Tantalo L, Eaton M, Rompalo AM, Raines C et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15034833 Normalization of cerebrospinal fluid abnormalities after neurosyphilis therapy: does HIV status matter?] ''Clin Infect Dis'' 38 (7):1001-6. [http://dx.doi.org/10.1086/382532 DOI:10.1086/382532] PMID: [http://pubmed.gov/15034833 15034833]</ref><ref name="pmid18525260">Ghanem KG, Moore RD, Rompalo AM, Erbelding EJ, Zenilman JM, Gebo KA (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18525260 Neurosyphilis in a clinical cohort of HIV-1-infected patients.] ''AIDS'' 22 (10):1145-51. [http://dx.doi.org/10.1097/QAD.0b013e32830184df DOI:10.1097/QAD.0b013e32830184df] PMID: [http://pubmed.gov/18525260 18525260]</ref>
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| *If the cell count has not decreased after 6 months or if the CSF is not normal after 2 years, retreatment should be considered.
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| ==Related chapters== | | ==Related chapters== |