Persistence of Treponema pallidum Following Penicillin G Therapy

Tramont, Edmund C.

doi:10.1001/jama.1976.03270200044030

Cited by 119 publications

(27 citation statements)

References 11 publications

(2 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There are currently no accepted regimens for the use of oral penicillin in the treatment of latent or neurosyphilis (7). The various parenteral regimens advocated are time-consuming and uncomfortable for patients and, in certain cases, have been associated with treatment failure or have produced undetectable levels of penicillin in cerebrospinal fluid (CSF) (4,6,12). This study was designed to examine the penetration of oral doxycycline into the CSF of patients with latent or neurosyphilis.…”

mentioning

confidence: 99%

Penetration of oral doxycycline into the cerebrospinal fluid of patients with latent or neurosyphilis

Yim¹,

Flynn²,

Fitzgerald³

1985

Antimicrob Agents Chemother

120

View full text Add to dashboard Cite

Five patients with laboratory evidence of latent or neurosyphilis were treated orally with doxycycline (200 mg) twice a day for 21 days. After the seventh dose, the mean level of doxycycline in serum was 5.8 ,ug/ml, with a mean drug level in cerebrospinal fluid of 1.3 ,Lg/ml. The mean penetration into cerebrospinal fluid was 26%. These preliminary findings suggest that doxycycline, administered orally at a dose of 200 mg twice a day, reaches a sufficient concentration in cerebrospinal fluid to be worthy of further evaluation as an alternative regimen to penicillin therapy for latent or neurosyphilis.

show abstract

mentioning

confidence: 99%

Penetration of oral doxycycline into the cerebrospinal fluid of patients with latent or neurosyphilis

Yim¹,

Flynn²,

Fitzgerald³

1985

Antimicrob Agents Chemother

120

View full text Add to dashboard Cite

show abstract

“…However, many experts are uncomfortable with this recommendation for several reasons. Currently recommended treatment for early or late (non-neurologic) syphilis with intramuscular benzathine penicillin G (BPG) does not achieve measurable concentrations of penicillin in CSF, and T. pallidum has been identified in CSF after treatment with BPG [19,23]. As noted previously, symptomatic neurosyphilis can occur quite early in the course of syphilis.…”

Section: Neuroinvasion and Clearancementioning

confidence: 96%

Neurosyphilis

Marra

2004

Curr Neurol Neurosci Rep

View full text Add to dashboard Cite

Treponema pallidum, the bacterium that causes syphilis, invades the central nervous system early in the course of disease but causes persistent infection in only a subset of infected persons. Individuals with persistent infection or asymptomatic meningitis are at risk for developing symptomatic neurosyphilis if they are not treated with a drug regimen that achieves sufficient drug levels in cerebrospinal fluid to kill the organism. In this article, recent studies that address the risk, diagnosis, and management of neurosyphilis are discussed within the context of a brief review. Particular attention is given to current controversies. In the developed world, these issues are particularly relevant to persons who are infected with HIV.

show abstract

“…Initially recognised in the pre-antibiotic era 39 and reported early in the penicillin era, 40 several more recent case studies report neurorelapse occurring in HIV-infected patients. 19,[41][42][43][44][45] While it is difficult to rule out the possibility of reinfection entirely in these case reports, it has also been hypothesised that neurorelapse may be more common in HIV-infected patients with syphilis because benzathine penicillin G, the usual treatment for uncomplicated syphilis, does not clear T. pallidum from the CNS, the eye or the inner ear 46,47 and HIV impairs cell-mediated immunity, allowing T. pallidum to persist at these sites. 41 Further systematic studies are needed to determine whether HIV co-infection truly increases the odds of neurorelapse with syphilis.…”

Section: Neurorelapse: Neurological Complications After Syphilis Treamentioning

confidence: 98%