The recent increase on the incidence of syphilis, mainly in the last 15 years with the emergence of AIDS, seems to lead to the augment of atypical cases observed in the dairy medical practice. The frequency in the co-infection HIV/syphilis among male homosexuals in larger urban centers varies from 20% to 70%. In these cases, ulcers are persistent, and the evolution to latter stages occurs in a faster way. Among the most severe complications of the untreated or unsuitable treated disease, neurosyphilis can develop, provoking several neurological and psychiatric symptoms and signals, sometimes disabling. Diagnosis can be done by cerebrospinal fluid (CSF) punction, permitting to evaluate cells number and proteins abnormalities as so treponemal and non-treponemal tests. CSF tests should be done in all patients with positive serological tests for syphilis, in neurological, ophthalmic, or tertiary disease, or in those who have failed therapy, and in HIV-infected patients with late latent syphilis or syphilis of unknown duration. However, neurolues is unlikely when serologic VDRL is negative. In those patients, CSF punction is not recommended. But this is reasonable certainly of neurolues when neuropsychiatric syndromes are present associated to reactive CSF VDRL.
Syphilis; Neurosyphilis; AIDS; Cerebrospinal fluid