Neurosyphilis

The incidence of syphilis has increased world-wide over the last ∼25 years, and this increase has been accompanied by a resurgence of neurosyphilis. This review sets the stage for understanding neurosyphilis by briefly summarizing the clinical and laboratory findings in uncomplicated syphilis. It then addresses the epidemiology, clinical manifestations and treatment of neurosyphilis, beginning with information from the pre-penicillin era and extending to modern studies. Ocular and otosyphilis are included as their treatment is the same as for neurosyphilis. Importantly, the review focuses on areas of uncertainty and controversy, including insights into pathogenesis, new diagnostic tests, the best way to identify individuals at risk for neurosyphilis, and the justification for identifying and treating asymptomatic neurosyphilis in selected situations.