Insights Into Treatment Alternatives for Neurosyphilis: Systematic Literature Review and Meta-Analysis

Area of Science:

• Infectious Diseases
• Neurology
• Pharmacology

Background:

• Neurosyphilis, a serious complication of syphilis, requires effective treatment.
• Penicillin G is the standard treatment, but concerns about resistance and availability exist.
• Alternative therapies are being investigated to broaden treatment options.

Purpose of the Study:

• To systematically review and meta-analyze the efficacy of alternative neurosyphilis treatments compared to penicillin monotherapy.
• To assess treatment response, reinfection rates, and adverse drug events.
• To evaluate the efficacy of intravenous ceftriaxone as an alternative to penicillin.

Main Methods:

• Systematic literature review and meta-analysis of studies comparing penicillin monotherapy with alternative treatments for neurosyphilis.
• Searched multiple databases (MEDLINE, Embase, Cochrane, etc.) from inception to September 2023.
• Random-effect models were used for pooled mean differences; focused on treatment response.

Main Results:

• Six studies met inclusion criteria; three provided quantitative data for meta-analysis.
• Intravenous ceftriaxone (2g daily for 10 days) showed similar efficacy to intravenous penicillin G (18-24 million units daily for 10 days) for neurosyphilis.
• No statistical difference was found between ceftriaxone and penicillin in individuals with human immunodeficiency virus (HIV).

Conclusions:

• Intravenous ceftriaxone appears to be a viable alternative to penicillin for neurosyphilis treatment.
• Ceftriaxone may expand treatment options, especially for patients with penicillin allergies or contraindications.
• Further studies on other alternatives, such as doxycycline, are warranted.