RT Journal Article SR Electronic T1 Neurosyphilis in patients with HIV JF Practical Neurology JO Pract Neurol FD BMJ Publishing Group Ltd SP 211 OP 218 DO 10.1136/practneurol-2017-001754 VO 18 IS 3 A1 Emily Hobbs A1 Jaime H Vera A1 Michael Marks A1 Andrew William Barritt A1 Basil H Ridha A1 David Lawrence YR 2018 UL http://pn.bmj.com/content/18/3/211.abstract 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.