Cardiovascular syphilis and neurosyphilis

Prednisolone 20 mg twice daily for two days prior to commencement of penicillin is recommended for patients with cardiovascular or neurosyphilis.

Aqueous procaine penicillin G 1.5 g daily intramuscularly with probenecid 500 mg four times daily by mouth for 21 days may be used for patients with cardiovascular syphilis and for patients with neurosyphilis managed as outpatients.

For patients with neurosyphilis treated as inpatients, intravenous benzylpenicillin G 4 g at four hourly intervals with probenecid 500 mg four times daily by mouth for 10 days may be used.

Asymptomatic patients with positive CSF findings should be treated as having neurosyphilis.

Patients with neurosyphilis should be referred for specialist advice. Benzathine penicillin should not be used for the treatment of neurosyphilis because an adequate level of penicillin in the CSF is not achieved. However, if the CSF examination is negative, benzathine penicillin G 1.8 g intramuscularly at 7 day intervals for 3 doses may be used for the treatment of cardiovascular or gummatous disease in patients unable to comply with daily injections.
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