Neurosyphilis with optic neuritis: An update

Abstract

The incidence of syphilis is rising Patients with neurosyphilis may present with ophthalmic symptoms and signs. Neurosyphilis should be considered in patients with otherwise unexplained visual loss, and syphilis should be considered as a cause of optic neuritis All suspected cases should be investigated with both a specific antitreponemal test and a lipid antigen test All patients with syphilis should be evaluated for HIV and vice versa Negative neuro-imaging and previous treatment with benzathine penicillin cannot be used to exclude a diagnosis of neurosyphilis Prolonged treatment with high dose intravenous penicillin remains the treatment of choice for neurosyphilis Concommitant use of bacteriostatic drugs, such as doxycyclin, may reduce the effectiveness of penicillin If adequately treated there is a good visual prognosis for patients with syphilitic optic neuritis.