Register      Login
Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
REVIEW (Open Access)

Neurosyphilis and the impact of HIV infection

Emily L. Ho A B D and Serena S. Spudich C
+ Author Affiliations
- Author Affiliations

A Department of Neurology, University of Washington, USA.

B Swedish Neuroscience Institute, 550 17th Avenue, 4West, Seattle, WA, 98122, USA.

C Department of Neurology, School of Medicine, PO Box 208018, Yale University, New Haven, CT, 06250, USA.

D Corresponding author. Email: hoel@u.washington.edu

Sexual Health 12(2) 148-154 https://doi.org/10.1071/SH14195
Submitted: 13 October 2014  Accepted: 18 January 2015   Published: 20 April 2015

Journal Compilation © CSIRO Publishing 2015 Open Access CC BY-NC-ND

Abstract

Neurosyphilis is a complication of systemic syphilis. This review of the clinical presentation, diagnostic laboratory findings, treatment and management of neurosyphilis discusses the impact of HIV and the specific challenges it brings, focusing on areas of controversy, and highlighting important questions that remain to be answered.


References

[1]  Chesson HW, Heffelfinger JD, Voigt RF, Collins D. Estimates of primary and secondary syphilis rates in persons with HIV in the United States, 2002. Sex Transm Dis 2005; 32 265–9.
Estimates of primary and secondary syphilis rates in persons with HIV in the United States, 2002.Crossref | GoogleScholarGoogle Scholar | 15849526PubMed |

[2]  World Health Organization. Global prevalence and incidence of selected curable sexually transmitted infections: overview and estimates. Geneva: World Health Organization; 2001.

[3]  Men who have Sex with Men (MSM)–Update for ICAAP, Bali; 2009. Available online at: http://www.aidsdatahub.org/sites/default/files/documents/China_MSM_Country_Snapshot__Aug_2009.pdf [verified 12 October 2014].

[4]  Herbert LJ, Middleton SI. An estimate of syphilis incidence in Eastern Europe. J Glob Health 2012; 2 010402
An estimate of syphilis incidence in Eastern Europe.Crossref | GoogleScholarGoogle Scholar | 23198131PubMed |

[5]  Kuklova I, Velcevsky P, Kojanova M. Syphilis among STD clinic patients in Prague in 2009. Cent Eur J Public Health 2011; 19 84–90.
| 21739897PubMed |

[6]  Tucker JD, Yin YP, Wang B, Chen XS, Cohen MS. An expanding syphilis epidemic in China: epidemiology, behavioural risk and control strategies with a focus on low-tier female sex workers and men who have sex with men. Sex Transm Infect 2011; 87 ii16–8.
An expanding syphilis epidemic in China: epidemiology, behavioural risk and control strategies with a focus on low-tier female sex workers and men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 22110145PubMed |

[7]  Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2010. Atlanta: U.S. Department of Health and Human Services; 2011.

[8]  Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2012. Atlanta: U.S. Department of Health and Human Services; 2013.

[9]  Savage EJ, Hughes G, Ison C, Lowndes CM. Syphilis and gonorrhoea in men who have sex with men: a European overview. Euro Comm Dis Bull 2009; 14 ii–19417.

[10]  Muessig KE, Tucker JD, Wang BX, Chen XS. HIV and syphilis among men who have sex with men in China: the time to act is now. Sex Transm Dis 2010; 37 214–6.
| 20220563PubMed |

[11]  Xu JJ, Zhang M, Brown K, Reilly K, Wang H, Hu Q,, Ding H, Chu Z, Bice T, Shang H. Syphilis and HIV seroconversion among a 12-month prospective cohort of men who have sex with men in Shenyang, China. Sex Transm Dis 2010; 37 432–9.
| 20375928PubMed |

[12]  Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2005 supplement, syphilis surveillance report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; December 2006.

[13]  Spindler HH, Scheer S, Chen SY, Klausner JD, Katz MH, Valleroy LA, Schwarcz SK. Viagra, methamphetamine, and HIV risk: results from a probability sample of MSM, San Francisco. Sex Transm Dis 2007; 34 586–91.
| 17334264PubMed |

[14]  Taylor MM, Aynalem G, Smith LV, Montoya J, Kerndt P. Methamphetamine use and sexual risk behaviours among men who have sex with men diagnosed with early syphilis in Los Angeles County. Int J STD AIDS 2007; 18 93–7.
Methamphetamine use and sexual risk behaviours among men who have sex with men diagnosed with early syphilis in Los Angeles County.Crossref | GoogleScholarGoogle Scholar | 17331279PubMed |

[15]  Centers for Disease Control and Prevention Symptomatic early neurosyphilis among HIV-positive men who have sex with men–four cities, United States, January 2002–June 2004. MMWR Morb Mortal Wkly Rep 2007; 56 625–8.
| 17597693PubMed |

[16]  Taylor MM, Aynalem G, Olea LM, He P, Smith LV, Kerndt PR. A consequence of the syphilis epidemic among men who have sex with men (MSM): neurosyphilis in Los Angeles, 2001–2004. Sex Transm Dis 2008; 35 430–4.
A consequence of the syphilis epidemic among men who have sex with men (MSM): neurosyphilis in Los Angeles, 2001–2004.Crossref | GoogleScholarGoogle Scholar | 18446083PubMed |

[17]  Brandt AM. No magic bullet: a social history of venereal disease in the United States since 1880. Oxford: Oxford University Press; 1987.

[18]  Davis LE, Schmitt JW. Clinical significance of cerebrospinal fluid tests for neurosyphilis. Ann Neurol 1989; 25 50–5.
Clinical significance of cerebrospinal fluid tests for neurosyphilis.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL1M7hslWjug%3D%3D&md5=08702a7eda39695b4cff0bbdcfcced5bCAS | 2643918PubMed |

[19]  Rolfs RT, Joesoef MR, Hendershot EF, Rompalo AM, Augenbraun MH, Chiu M,, Bolan G, Johnson SC, French P, Steen E, Radolf JD, Larsen S. A randomized trial of enhanced therapy for early syphilis in patients with and without human immunodeficiency virus infection. The Syphilis and HIV Study Group. N Engl J Med 1997; 337 307–14.
A randomized trial of enhanced therapy for early syphilis in patients with and without human immunodeficiency virus infection. The Syphilis and HIV Study Group.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2szmsFSnsg%3D%3D&md5=7e459a6433005d1430c7a1e302b13b3cCAS | 9235493PubMed |

[20]  Marra CM, Tantalo LC, Maxwell CL, Ho EL, Sahi SK, Jones T. The rapid plasma reagin test cannot replace the venereal disease research laboratory test for neurosyphilis diagnosis. Sex Transm Dis 2012; 39 453–7.
The rapid plasma reagin test cannot replace the venereal disease research laboratory test for neurosyphilis diagnosis.Crossref | GoogleScholarGoogle Scholar | 22592831PubMed |

[21]  Centers for Disease Control and Prevention Sexually transmitted diseases treatment guidelines, 2010. MMWR Morb Mort Wkly Rep 2010; 59 26–39.

[22]  Kaplan JE, Benson C, Holmes KK, Brooks JT, Pau A, Masur H. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Morb Mortality Wkly Report 2009; 58 1–207.

[23]  Marra CM, Maxwell CL, Collier AC, Robertson KR, Imrie A. Interpreting cerebrospinal fluid pleocytosis in HIV in the era of potent antiretroviral therapy. BMC Infect Dis 2007; 7 37
Interpreting cerebrospinal fluid pleocytosis in HIV in the era of potent antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar | 17475004PubMed |

[24]  Marra CM, Maxwell CL, Smith SL, Lukehart SA, Rompalo AM, Eaton M, et al Cerebrospinal fluid abnormalities in patients with syphilis: association with clinical and laboratory features. J Infect Dis 2004; 189 369–76.
Cerebrospinal fluid abnormalities in patients with syphilis: association with clinical and laboratory features.Crossref | GoogleScholarGoogle Scholar | 14745693PubMed |

[25]  Ghanem KG, Moore RD, Rompalo AM, Erbelding EJ, Zenilman JM, Gebo KA. Lumbar puncture in HIV-infected patients with syphilis and no neurologic symptoms. Clin Infect Dis 2009; 48 816–21.
Lumbar puncture in HIV-infected patients with syphilis and no neurologic symptoms.Crossref | GoogleScholarGoogle Scholar | 19187028PubMed |

[26]  Spudich SS, Nilsson AC, Lollo ND, Liegler TJ, Petropoulos CJ, Deeks SG, Paxinos EE, Price RW. Cerebrospinal fluid HIV infection and pleocytosis: relation to systemic infection and antiretroviral treatment. BMC Infect Dis 2005; 5 98
Cerebrospinal fluid HIV infection and pleocytosis: relation to systemic infection and antiretroviral treatment.Crossref | GoogleScholarGoogle Scholar | 16266436PubMed |

[27]  Marra CM, Tantalo LC, Maxwell CL, Dougherty K, Wood B. Alternative cerebrospinal fluid tests to diagnose neurosyphilis in HIV-infected individuals. Neurology 2004; 63 85–8.
Alternative cerebrospinal fluid tests to diagnose neurosyphilis in HIV-infected individuals.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2czks1Krsw%3D%3D&md5=3f6146a15a74b259cdfcf97633b3724bCAS | 15249615PubMed |

[28]  Marra CM, Tantalo LC, Sahi SK, Maxwell CL, Lukehart SA. CXCL13 as a cerebrospinal fluid marker for neurosyphilis in HIV-infected patients with syphilis. Sex Transm Dis 2010; 37 283–7.
| 1:CAS:528:DC%2BC3cXnsVOktbk%3D&md5=3d212143af0505c5d89921ad487fa573CAS | 20393380PubMed |

[29]  Rupprecht TA, Kirschning CJ, Popp B, Kastenbauer S, Fingerle V, Pfister HW, et al Borrelia garinii induces CXCL13 production in human monocytes through Toll-like receptor 2. Infect Immun 2007; 75 4351–6.
Borrelia garinii induces CXCL13 production in human monocytes through Toll-like receptor 2.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2sXpvFGhtr8%3D&md5=618d5c64e46dc6742e3e87f8645200e5CAS | 17562761PubMed |

[30]  Dumaresq J, Langevin S, Gagnon S, Serhir B, Deligne B, Tremblay C, Tsang RS, Fortin C, Coutlee F, Roger M. Clinical prediction and diagnosis of neurosyphilis in HIV-infected patients with early syphilis. J Clin Microbiol 2013; 51 4060–6.
Clinical prediction and diagnosis of neurosyphilis in HIV-infected patients with early syphilis.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC2MXjtlWrtro%3D&md5=b2c812346a9d0f0ce577ede1bd4c88e0CAS | 24088852PubMed |

[31]  Libois A, De Wit S, Poll B, Garcia F, Florence E, Del Rio A, Sanchez P, Negredo E, Vandenbruaene M, Gatell JM, Clumeck N. HIV and syphilis: when to perform a lumbar puncture. Sex Transm Dis 2007; 34 141–4.
HIV and syphilis: when to perform a lumbar puncture.Crossref | GoogleScholarGoogle Scholar | 16865051PubMed |

[32]  Ghanem KG, Moore RD, Rompalo AM, Erbelding EJ, Zenilman JM, Gebo KA. Neurosyphilis in a clinical cohort of HIV-1-infected patients. AIDS 2008; 22 1145–51.
Neurosyphilis in a clinical cohort of HIV-1-infected patients.Crossref | GoogleScholarGoogle Scholar | 18525260PubMed |

[33]  Agmon-Levin N, Elbirt D, Asher I, Gradestein S, Werner B, Sthoeger Z. Syphilis and HIV co-infection in an Israeli HIV clinic: incidence and outcome. Int J STD AIDS 2010; 21 249–52.
Syphilis and HIV co-infection in an Israeli HIV clinic: incidence and outcome.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3c3kvFSqtA%3D%3D&md5=cb150c6c1ccdbd96dd02a03f94359230CAS | 20378895PubMed |

[34]  Leber A, MacPherson P, Lee BC. Epidemiology of infectious syphilis in Ottawa. Recurring themes revisited. Canadian J Public Health 2008; 99 401–5.

[35]  Wang YJ, Chi CY, Chou CH, Ho CM, Lin PC, Liao CH, et al Syphilis and neurosyphilis in human immunodeficiency virus-infected patients: a retrospective study at a teaching hospital in Taiwan. J Micro Immunol Infection 2012; 45 337–42.
Syphilis and neurosyphilis in human immunodeficiency virus-infected patients: a retrospective study at a teaching hospital in Taiwan.Crossref | GoogleScholarGoogle Scholar |

[36]  de Almeida SM, Bhatt A, Riggs PK, Durelle J, Lazzaretto D, Marquie-Beck J, McCutchan A, Letendre S, Ellis R. Cerebrospinal fluid human immunodeficiency virus viral load in patients with neurosyphilis. J Neurovirol 2010; 16 6–12.
Cerebrospinal fluid human immunodeficiency virus viral load in patients with neurosyphilis.Crossref | GoogleScholarGoogle Scholar | 20132081PubMed |

[37]  Public Health Agency of Canada. Canadian guidelines on sexually transmitted infections 2013 Available online at: http://www.phac-aspc.gc.ca/std-mts/sti-its/cgsti-ldcits/section-5-10-eng.php [cited 12 October 2014].

[38]  Janier M, Hegyi V, Dupin N, Unemo M, Tiplica GS, Potocnik M, French P, Patel R. 2014 European guideline on the management of syphilis. J EuroAcademy Dermatol Venereol 2014; 28 1581–93.
2014 European guideline on the management of syphilis.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2M3js1Citw%3D%3D&md5=81f54d9f21b643e575d49519756748efCAS |

[39]  Moore JEGM. Syphilitic iritis. A study of 249 patients. Am J Ophthalmol 1931; 14 110–26.
Syphilitic iritis. A study of 249 patients.Crossref | GoogleScholarGoogle Scholar |

[40]  Laird SM. Neuro-recurrence after penicillin therapy of secondary syphilis. Urol Cutaneous Rev 1951; 55 475–7.
| 1:STN:280:DyaG3M%2FosFCltg%3D%3D&md5=7f346b125089c56c19a72b27a05bf64fCAS | 14855914PubMed |

[41]  Musher DM. Syphilis, neurosyphilis, penicillin, and AIDS. J Infect Dis 1991; 163 1201–6.
Syphilis, neurosyphilis, penicillin, and AIDS.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3M3ksFWlsg%3D%3D&md5=fb42ad98498886862cc83d325c6057deCAS | 2037785PubMed |

[42]  Inungu J, Morse A, Gordon C. Neurosyphilis during the AIDS epidemic, New Orleans, 1990–1997. J Infect Dis 1998; 178 1229
Neurosyphilis during the AIDS epidemic, New Orleans, 1990–1997.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M%2FitlSitA%3D%3D&md5=5953cd7ff807e3c8475af261cfd39b8bCAS | 9806069PubMed |

[43]  McLeish WM, Pulido JS, Holland S, Culbertson WW, Winward K. The ocular manifestations of syphilis in the human immunodeficiency virus type 1-infected host. Ophthalmology 1990; 97 196–203.
The ocular manifestations of syphilis in the human immunodeficiency virus type 1-infected host.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3c3itFCmtw%3D%3D&md5=445723822032a0f76b41d1783d5b23eaCAS | 2326008PubMed |

[44]  Shalaby IA, Dunn JP, Semba RD, Jabs DA. Syphilitic uveitis in human immunodeficiency virus-infected patients. Arch Ophthalmol 1997; 115 469–73.
Syphilitic uveitis in human immunodeficiency virus-infected patients.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2s3mtlyrsA%3D%3D&md5=5e3707c9686e431995e30005c33871cdCAS | 9109754PubMed |

[45]  Walter T, Lebouche B, Miailhes P, Cotte L, Roure C, Schlienger I, Trepo C. Symptomatic relapse of neurologic syphilis after benzathine penicillin G therapy for primary or secondary syphilis in HIV-infected patients Clin Infect Dis 2006; 43 787–90.
Symptomatic relapse of neurologic syphilis after benzathine penicillin G therapy for primary or secondary syphilis in HIV-infected patientsCrossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD28voslWruw%3D%3D&md5=3b1dc6b60147ed343341059d9e641e43CAS | 16912958PubMed |

[46]  Lukehart SA, Hook EW, Baker-Zander SA, Collier AC, Critchlow CW, Handsfield HH. Invasion of the central nervous system by Treponema pallidum: implications for diagnosis and treatment. Ann Intern Med 1988; 109 855–62.
Invasion of the central nervous system by Treponema pallidum: implications for diagnosis and treatment.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL1M%2FkvVKktA%3D%3D&md5=16cbf9a1d603c8c687637a3b80f34c71CAS | 3056164PubMed |

[47]  Tramont EC. Persistence of Treponema pallidum following penicillin G therapy. Report of two cases. JAMA 1976; 236 2206–7.
Persistence of Treponema pallidum following penicillin G therapy. Report of two cases.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaE2s%2FjtF2ltg%3D%3D&md5=ceb4ae3153b78d862b032ea372640832CAS | 789927PubMed |

[48]  Hook EW, Baker-Zander SA, Moskovitz BL, Lukehart SA, Handsfield HH. Ceftriaxone therapy for asymptomatic neurosyphilis. Case report and Western blot analysis of serum and cerebrospinal fluid IgG response to therapy. Sex Transm Dis 1986; 13 185–8.
Ceftriaxone therapy for asymptomatic neurosyphilis. Case report and Western blot analysis of serum and cerebrospinal fluid IgG response to therapy.Crossref | GoogleScholarGoogle Scholar | 3764632PubMed |

[49]  Gentile JH, Viviani C, Sparo MD, Arduino RC. Syphilitic meningomyelitis treated with ceftriaxone: case report. Clin Infect Dis 1998; 26 528
Syphilitic meningomyelitis treated with ceftriaxone: case report.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c7mtFKjtA%3D%3D&md5=3448aacddc065f5db3fd16c156a6715eCAS | 9502500PubMed |

[50]  Milger K, Fleig V, Kohlenberg A, Discher T, Lohmeyer J. Neurosyphilis manifesting with unilateral visual loss and hyponatremia: a case report. BMC Infect Dis 2011; 11 17
Neurosyphilis manifesting with unilateral visual loss and hyponatremia: a case report.Crossref | GoogleScholarGoogle Scholar | 21235811PubMed |

[51]  Shann S, Wilson J. Treatment of neurosyphilis with ceftriaxone. Sex Transm Infect 2003; 79 415–6.
Treatment of neurosyphilis with ceftriaxone.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3svpslaquw%3D%3D&md5=258ea94c6a0de1fd9cd5d44a79695657CAS | 14573840PubMed |

[52]  Marra CM, Boutin P, McArthur JC, Hurwitz S, Simpson PA, Haslett JA, van der Horst C, Nevin T, Hook EW. A pilot study evaluating ceftriaxone and penicillin G as treatment agents for neurosyphilis in human immunodeficiency virus-infected individuals. Clin Infect Dis 2000; 30 540–4.
A pilot study evaluating ceftriaxone and penicillin G as treatment agents for neurosyphilis in human immunodeficiency virus-infected individuals.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD3cXjtVamsb0%3D&md5=893ab1ce26f586f73a51050e35c156c4CAS | 10722441PubMed |

[53]  Smith NH, Musher DM, Huang DB, Rodriguez PS, Dowell ME, Ace W, White AC. Response of HIV-infected patients with asymptomatic syphilis to intensive intramuscular therapy with ceftriaxone or procaine penicillin. Int J STD AIDS 2004; 15 328–32.
Response of HIV-infected patients with asymptomatic syphilis to intensive intramuscular therapy with ceftriaxone or procaine penicillin.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2c3hvFyguw%3D%3D&md5=b045daa69453fb4369be0d206da4dbfeCAS | 15117503PubMed |

[54]  Dobbin JM, Perkins JH. Otosyphilis and hearing loss: response to penicillin and steroid therapy. Laryngoscope 1983; 93 1540–3.
Otosyphilis and hearing loss: response to penicillin and steroid therapy.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL2c%2Fms12guw%3D%3D&md5=1e0b88ee756057c18a7925acc7f799c5CAS | 6645754PubMed |

[55]  Linstrom CJ, Gleich LL. Otosyphilis: diagnostic and therapeutic update. J Otolaryngol 1993; 22 401–8.
| 1:STN:280:DyaK2c3htVGrtA%3D%3D&md5=dcf4c5a80e80c25b00dfc1a546481af3CAS | 8158733PubMed |

[56]  Kiss S, Damico FM, Young LH. Ocular manifestations and treatment of syphilis. Semin Ophthalmol 2005; 20 161–7.
Ocular manifestations and treatment of syphilis.Crossref | GoogleScholarGoogle Scholar | 16282150PubMed |

[57]  Tucker JD, Li JZ, Robbins GK, Davis BT, Lobo AM, Kunkel J, Papaliodis GN, Durand ML, Felsenstein D. Ocular syphilis among HIV-infected patients: a systematic analysis of the literature. Sex Transm Infect 2011; 87 4–8.
Ocular syphilis among HIV-infected patients: a systematic analysis of the literature.Crossref | GoogleScholarGoogle Scholar | 20798396PubMed |

[58]  Marra CM, Maxwell CL, Tantalo LC, Sahi SK, Lukehart SA. Normalization of serum rapid plasma reagin titer predicts normalization of cerebrospinal fluid and clinical abnormalities after treatment of neurosyphilis. Clin Infect Dis 2008; 47 893–9.
Normalization of serum rapid plasma reagin titer predicts normalization of cerebrospinal fluid and clinical abnormalities after treatment of neurosyphilis.Crossref | GoogleScholarGoogle Scholar | 18715154PubMed |

[59]  Gordon SM, Eaton ME, George R, Larsen S, Lukehart SA, Kuypers J, Marra CM, Thompson S. The response of symptomatic neurosyphilis to high-dose intravenous penicillin G in patients with human immunodeficiency virus infection N Engl J Med 1994; 331 1469–73.
The response of symptomatic neurosyphilis to high-dose intravenous penicillin G in patients with human immunodeficiency virus infectionCrossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2M%2FlvFamsg%3D%3D&md5=48c42f299612ccb0fe8582f0c01b1c9dCAS | 7969296PubMed |

[60]  Malone JL, Wallace MR, Hendrick BB, LaRocco A, Tonon E, Brodine SK,, Bowler WA, Lavin BS, Hawkins RE, Oldfield EC. Syphilis and neurosyphilis in a human immunodeficiency virus type-1 seropositive population: evidence for frequent serologic relapse after therapy. Am J Med 1995; 99 55–63.
Syphilis and neurosyphilis in a human immunodeficiency virus type-1 seropositive population: evidence for frequent serologic relapse after therapy.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2MzitFemsA%3D%3D&md5=25bd7162130cbcfa627f91d2825e4301CAS | 7598143PubMed |

[61]  Dibbern DA, Ray SC. Recrudescence of treated neurosyphilis in a patient with human immunodeficiency virus. Mayo Clin Proc 1999; 74 53–6.
Recrudescence of treated neurosyphilis in a patient with human immunodeficiency virus.Crossref | GoogleScholarGoogle Scholar | 9987533PubMed |

[62]  Marra CM, Longstreth WT, Maxwell CL, Lukehart SA. Resolution of serum and cerebrospinal fluid abnormalities after treatment of neurosyphilis. Influence of concomitant human immunodeficiency virus infection. Sex Transm Dis 1996; 23 184–9.
Resolution of serum and cerebrospinal fluid abnormalities after treatment of neurosyphilis. Influence of concomitant human immunodeficiency virus infection.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK28zjt12ksQ%3D%3D&md5=1e09a8dffb84ee1428b92603ff9b624fCAS | 8724507PubMed |

[63]  Marra CM, Maxwell CL, Tantalo L, Eaton M, Rompalo AM, Raines C, Stoner BP, Corbett JJ, Augenbraun M, Zajackowski M, Kee R, Lukehart SA. Normalization of cerebrospinal fluid abnormalities after neurosyphilis therapy: does HIV status matter? Clin Infect Dis 2004; 38 1001–6.
Normalization of cerebrospinal fluid abnormalities after neurosyphilis therapy: does HIV status matter?Crossref | GoogleScholarGoogle Scholar | 15034833PubMed |

[64]  Amaratunge BC, Camuglia JE, Hall AJ. Syphilitic uveitis: a review of clinical manifestations and treatment outcomes of syphilitic uveitis in human immunodeficiency virus-positive and negative patients. Clin Experiment Ophthalmol 2010; 38 68–74.
Syphilitic uveitis: a review of clinical manifestations and treatment outcomes of syphilitic uveitis in human immunodeficiency virus-positive and negative patients.Crossref | GoogleScholarGoogle Scholar | 20447104PubMed |