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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.
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