Neurosyphilis 12 years after treatment of a primary infection in a meanwhile HIV-infected patient

A 33-year-old male HIV-positive patient developed pure right motor hemiplegia due to meningovascular neurosyphilis. 12 years ago he was successfully treated for early syphilis with a single dose of 2,4 million units penicillin G benzathine without subsequent evidence of new infection or disease progression. Repeated HIV tests remained negative until 1993 when the HIV infection was diagnosed. It is well known that Treponema pallidum, the etiologic agent of syphilis, may be detected in the cerebrospinal fluid during early infection. Thus the former recommended regimen of single-dose penicillin G benzathine may not reliably eradicate T. pallidum from the CNS. Residual organisms may serve as a reservoir for relapse and dissemination in an immunocompromised host.