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In four of the seven patients studied 24 weeks after treatment,the serum titers on rapid plasma reagin(RPR)testing decreased by at least two doubling dilutions,and four patients had reductions in the cerebrospinal fluid titers on VDRL testing or reverted to nonreactive results.In two patients there was no normalization or improvement in serum titers on RPR testing or cerebrospinal fluid titers on VDRL testing,cell counts or protein concentrations.One patient relapsed with meningovascular syphilis six months after therapy.T.pallidum was detected by the polymerase chain reaction in cerebrospinal fluid from 3 of 10 patients before treatment,but in none of the 10 post-treatment specimens.In patients with early syphilis who are also infected with HIV,therapy with penicillin G benzathine may fail and neurosyphilis may develop.The regimen of high dose penicillin recommended for neurosyphilis is not consistently effective in patients infected with HIV. |
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