German guidelines on the diagnosis and treatment of neurosyphilis

Matthias Klein; Klemens Angstwurm; Stefan Esser; Kathrin Hahn; Matthias Maschke; Simone Scheithauer; Helmut Schoefer; Matthias Sturzenegger; Brigitte Wildemann; Jörg Weber

doi:10.1186/s42466-020-00081-1

German guidelines on the diagnosis and treatment of neurosyphilis

Neurol Res Pract. 2020 Nov 17:2:33. doi: 10.1186/s42466-020-00081-1. eCollection 2020.

Authors

Affiliations

¹ Department of Neurology, LMU Klinikum Muenchen, Marchioninistr. 15, 81377 Munich, Germany.
² Department of Neurology, Universitaetsklinik Regensburg, Universitaetsstr. 84, 93042 Regensburg, Germany.
³ Department of Dermatology, Universitaetsklinikum Essen, Hufelandstrasse 55, 45147 Essen, Germany.
⁴ Department of Neurology, Charite Berlin, Chariteplatz 1, 10117 Berlin, Germany.
⁵ Department of Neurology, Krankenhaus der Barmherzigen Brueder Trier, Nordallee 1, 54292 Trier, Germany.
⁶ Institute for Hygiene and Infectiology, Universitaet Goettingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
⁷ Dr. Horst Schmidt Kliniken, Aukamm-Allee 33, 65191 Wiesbaden, Germany.
⁸ Department of Neurology, Inselspital Bern, Freiburgstrasse 15, 3010 Bern, Switzerland.
⁹ Department of Neurology, Universitaetsklinik Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany.
¹⁰ Department of Neurology, Klinikum Klagenfurt, Feschnigstraße 11, 9020 Klagenfurt am Wörthsee, Austria.

Abstract

Introduction: In view of the importance of neurosyphilis and the difficulties encountered in diagnosing it, the S1 guideline "Neurosyphilis" has been published by the German Society for Neurology (DGN) in accordance with the stipulations of the Association of the Scientific Medical Societies in Germany (AWMF). The present article is an abridged translation of that German guideline.

Main recommendations: (a) Neurosyphilis can manifest as early neurosyphilis (meningitis, meningovascular neurosyphilis or syphilitic gummas) or late neurosyphilis (tabes dorsalis, general paresis). (b) The following diagnostic criteria help to establish the presence of probable neurosyphilis (always point iv, accompanied by any two of points i to iii): (i) subacute or chronic neuro-psychiatric symptoms; (ii) increased cerebrospinal fluid (CSF) cell count or signs of blood-CSF barrier disruption; (iii) positive effect of anti-neurosyphilis antibiotic therapy on clinical course and CSF findings; (iv) positive TPHA/TPPA or FTA test in serum. (c) The diagnosis of neurosyphilis is confirmed by the subsequent detection of intrathecal production of antibodies against Treponema pallidum. (d) In neurosyphilis, treatment with intravenous penicillin or ceftriaxone for 14 days is recommended. (e) The following parameters can be used to assess a therapeutic effect: clinical findings, serum VDRL, and CSF cell count.

Conclusion: The German guideline on the diagnosis and treatment of neurosyphilis is a practical tool to support clinicians in diagnosing and treating patients with neurosyphilis. This article is an abridged translation of this guideline (Klein MW, J.; Angstwurm, K.; Esser, S.; Hahn, K.; Matschke, M.; Scheithauer, S.; Schoefer, H.; Sturzenegger, M.; Wildemann, B. Neurosyphilis, S1-Leitlinie. Deutsche Gesellschaft für Neurologie, Leitlinien für Diagnostik und Thearpie in der Neurologie 2020).