Modern neurosyphilis--a critical analysis

Neurosyphilis remains a source of perplexity for today's physicians. Controversies exist over the interpretation of serologic tests, cerebrospinal fluid (CSF) abnormalities, diagnostic criteria, and treatment regimens. Its occurrence with human immunodeficiency virus (HIV) infection has raised fears of its recrudescence. A critical analysis of the evidence behind these viewpoints leads to several conclusions: the CSF VDRL is the most appropriate diagnostic test; pleocytosis is the only reliable CSF measure of disease activity; commonly accepted diagnostic criteria do not exclude nonsyphilitic disease; and treatment requires the prolonged use of parenteral penicillin, but no superior regimen has been found. Most data do not currently support the view that concurrent HIV infection produces accelerated or resistant neurosyphilis.