Syphilis and HIV

Most clinicians treat HIV-infected patients with syphilis and normal CSF with standard penicillin doses for the stage of syphilis, but some patients may need higher doses or  longer treatment. Even high-dose IV therapy fails to cure neurosyphilis in up to 25% of HIV-infected patients. Controversy exists as to whether subclinical or asymptomatic neurosyphilis, which is common, regardless of the stage of infection, in patients with high titers (>1:32) of non-treponemal serological tests and in HIV-infected persons with CD4 lymphocyte counts <350 cells/mm3, should be treated with high-dose penicillin in the same manner as symptomatic neurosyphilis.