NEUROSYPHILIS
WILLIAM H. TIMBERLAKE
The use of cardiolipin antigen especially in quantitative serologic techniques is highly satisfactory for the diagnosis and in following the course of treatment in syphilis. Persistent positive serology is not an indication for retreatment.
A positive TPI test with a negative serologic test enables one to make a retrospective diagnosis of syphilis. The exceptions to a diagnosis of "false positive" serology when the TPI is negative are the patients whose syphilis was treated in the early stage before TPI antibody could develop and a few patients with obvious late syphilis. When a chronic "false positive" serology has been identified the collagen diseases should be sought.
We still lack a technique that will indicate the survival of treponemes in the host following treatment.
Six-hundred thousand units of procaine penicillin G given daily to a total of 9 million units is the treatment of choice for neurosyphilis. This may be superseded soon by doses of benzyl amine penicillins half this size, and causing fewer side effects.
The major problem of syphilology now is the increasing difficulty of early case finding and control.
