Treatment of Neurosyphilis

In 1976, following a careful review of available clinical and experimental information¹ the Centers for Disease Control (CDC) published its current recommendations for the treatment of syphilis.² Such recommendations are ideally based on carefully evaluated, extensive clinical experience, but this is not the case for neurosyphilis. In only two small series has the treatment of neurosyphilis with penicillin G benzathine been prospectively evaluated. So few patients were studied that 95% confidence limits applied to the data suggest a cure rate as low as 67% with a single administration of 2.4 million units of penicillin G benzathine³ and as low as 81% with treatment consisting of two such doses given one week apart.⁴ Controlled studies are completely lacking on the current recommendation for three or four such doses of penicillin G benzathine administered at weekly intervals. When good data are not available, recommendations tend to be formulated