PT - JOURNAL ARTICLE AU - Emily Hobbs AU - Jaime H Vera AU - Michael Marks AU - Andrew William Barritt AU - Basil H Ridha AU - David Lawrence TI - Neurosyphilis in patients with HIV AID - 10.1136/practneurol-2017-001754 DP - 2018 Jun 01 TA - Practical Neurology PG - 211--218 VI - 18 IP - 3 4099 - http://pn.bmj.com/content/18/3/211.short 4100 - http://pn.bmj.com/content/18/3/211.full SO - Pract Neurol2018 Jun 01; 18 AB - Syphilis is a resurgent sexually transmitted infection in the UK that is disproportionately diagnosed in patients living with HIV, particularly in men who have sex with men. Syphilis appears to present differently in patients with HIV, particularly in those with severe immunosuppression. Progression to neurosyphilis is more common in HIV coinfection and can be asymptomatic, often for several years. The presentations of neurosyphilis vary but can include meningitis, meningovascular disease, general paresis and tabes dorsalis. There is debate about the circumstances in which to perform a lumbar puncture, and the current gold standard diagnostics have inadequate sensitivity. We recommend a pragmatic approach to lumbar punctures, interpreting investigations and deciding when to consider treatment with a neuropenetrative antibiotic regimen.