TREATMENT OF NEUROSYPHILIS
When treatment is instituted early, clinical features are expected to be completely reversible. When treatment is delayed pathological changes are partly reversible. So it is advisable to do LP and CSF study in all patients having syphilis of more than 1 year’s duration. When neurological Signs are present CSF examination is a must.
Ideally, three days of steroid therapy such as Prednisolone 40 mg daily may be given to prevent Herxheimer’s reaction which is usually seen in cases of GPI or in association of hypercellularity of CSF. After this, Procaine Penicillin 600,000 units daily is given by IM route for 21 days. For better penetration and CSF concentration now-a-days dry crystalline Penicilline G 2-4 million units every 4 hourly IV in continuous drip for 10-14 days is advocated. This regime is also suitable for HIV infected subjects. Alternately 2-4 million units of Procaine Penicillin IM once daily with Probenecid 500 mg 4 times daily orally may be given for 10-14 days. Alternative therapy to Penicillin for treatment of Neurosyphilis has not been confirmed and established. Ceftriaxone (2 gm daily, IM or IV) for 10-14 days can be taken as alternative to Penicillin. These are useful but not recommended. CSF study at 6 months interval should be done to see reversal of changes. A second course of Penicillin therapy may be given at 6 months or at 2 years if slightest CSF change exists. The first change is decrease in the number of cells in CSF (normal within three months) then protein level is diminished (normal within six months) and then Lange’s colloidal gold curve becomes normal (usually after 1 year). VDRL test may remain positive throughout life. Lumbar puncture should be repeated after every six months for a total period of two years to note the activity of the disease.
Pyretotherapy by inoculation with malarial parasite or by IV injection of E. coli vaccine is seldom practised now-a-days and is dangerous.