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Review
. 2018 Jun;18(3):211-218.
doi: 10.1136/practneurol-2017-001754. Epub 2018 Feb 24.

Neurosyphilis in Patients With HIV

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Free article
Review

Neurosyphilis in Patients With HIV

Emily Hobbs et al. Pract Neurol. .
Free article

Abstract

Syphilis is a resurgent sexually transmitted infection in the UK that is disproportionately diagnosed in patients living with HIV, particularly in men who have sex with men. Syphilis appears to present differently in patients with HIV, particularly in those with severe immunosuppression. Progression to neurosyphilis is more common in HIV coinfection and can be asymptomatic, often for several years. The presentations of neurosyphilis vary but can include meningitis, meningovascular disease, general paresis and tabes dorsalis. There is debate about the circumstances in which to perform a lumbar puncture, and the current gold standard diagnostics have inadequate sensitivity. We recommend a pragmatic approach to lumbar punctures, interpreting investigations and deciding when to consider treatment with a neuropenetrative antibiotic regimen.

Keywords: HIV; neurosyphilis; syphilis.

Conflict of interest statement

Competing interests: None declared.

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