Abstract:

Syphilis is one of the most common sexually transmitted diseases in China, and neurosyphilis is the most serious and common complication of syphilis. According to the report from National Center for Sexually Transmitted Diseases Control, Chinese Center for Disease Control and Prevention, the incidence of syphilis in China increased year by year from 2014 to 2019, which increased from 30.93/100 000 in 2014 to 38.37/100 000 in 2019, and the incidence of neurosyphilis was also increasing with a rising trend. Neurosyphilis is a chronic infectious disease caused by treponema pallidum invasion of brain, spinal cord and peripheral nerve and may occur in every stage of syphilis, it is generally believed that about 20% of untreated syphilis patients will develop asymptomatic neurosyphilis eventually and 10% of asymptomatic neurosyphilis may furtherly progress to symptomatic neurosyphilis. At present, there is no golden standard for the diagnosis of neurosyphilis, and the diagnosis of neurosyphilis depends on a comprehensive analysis of the patient’s medical history, symptoms, signs, laboratory, electrophysiology, neuropsychology and neuroimaging. Antibiotics currently used in clinical treatment of neurosyphilis include β-lactam, tetracycline and macrolides, and penicillin is the first choice. The success of neurosyphilis drug treatment mainly depends on the effective concentration and maintenance period of antibiotics in cerebrospinal fluid, and the concentration of penicillin should be higher than 0.018 mg/L toeliminate treponema pallidum in cerebrospinal fluid. Recommended regimen for neurosyphilis: aqueous crystalline penicillin G 18-24 million units per day, administered as 3-4 million units through intravenous injection every 4 hours for 10-14 days, followed by benzathine penicillin, 2.4 million units per week, intramuscular injection for 3 weeks; Or Procaine penicillin G 2.4 million units intramuscular injection once daily plus Probenecid 500 mg orally 4 times/day, both for 10-14 days followed by benzathine penicillin, 2.4 million units per week, intramuscular injection for 3 weeks. Multidisciplinary collaboration is of great significance for the early rehabilitation of patients with neurosyphilis, which can effectively improve the patients’ mental and systemic symptoms. The applicability of glucocorticoids in the treatment of neurosyphilis remains to be discussed. And the indications, frequency and efficacy of gamma globulin in neurosyphilis patients need to be furtherly studied.

Key words: Neurosyphilis, Diagnosis, Antibiotics, Multiple disciplinary treatment