In 2011 the patient had tested positive for a “venereal disease” and was treated with 2-3 intramuscular injections
Ocular syphilis (Neurosyphilis)
Syphilis is an infection of the spirochete T. Pallidum. It is spread through direct contact with a chancre; transmission occurs during sexual contact. Pregnant women can also transmit the disease through the placenta within the first 16 weeks of pregnancy.
Syphilis is characterized by the phases of infectious process:
Microhemagglutination test for antibodies to T. pallidum (MHA-TP)
T. pallidum particle agglutination assay (TPPA)
T. pallidum enzyme immunoassay (TP- EIA)
Chemiluminescence immunoassay (CLIA)
Positive for life
Negative Non-Treponemal Test
For most patients this precludes a diagnosis of active syphilis
If symptomatic consider:
Early empiric treatment (seroreversion)
In early syphilis: Testing could be prior to Antibody formation, or prozone reaction (2 percent)
Late syphilis: advanced immunosuppression (B cell failure), natural history
Interpretation of CSF
VDRL in CSF = highly specific; poor sensitivity
If positive establishes the diagnosis
FTA-ABS can be ordered = sensitive; not specific
CSF-VDRL false+: traumatic tap when serum nontreponemal titer high
Pleocytosis >5 and Protein >45 is consistent with the diagnosis, but is also non specific
Non-specific pleocytosis also occurs in setting of HIV infection and makes interpretation difficult
Treat ocular syphilis as neurosyphilis
Aqueous crystalline penicillin G (18 to 24 million units per day)
3 to 4 mil units IV q 4 H 10 to 14 days
Desensitization in patients with severe allergy
May consider doxycycline and ceftriaxone as alternatives in patients with severe allergy (excluding pregnancy)
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