Treatment Desired Outcome

After confirming the diagnosis of syphilis, the desired outcome is a fourfold decrease in quantitative nontreponemal titers over a 6-month period and within 12 to 24 months after treatment of latent or late syphilis. An algorithm for the treatment of syphilis is shown in Figure 80-1.

With regard to neurosyphilis, a reduction in neurologic manifestations is desired, which may include seizures, paresis, hyperreflexia, visual disturbances, hearing loss, neuropathy, or loss of bowel and bladder function. In late neurosyphilis, vascular lesions (meningovascular neurosyphilis) may also be observed; thus, a reduction in the number of observed lesions is warranted. A diminution in CSF WBC (less than 10 x 103/mm3 [10 x 109/L]) or protein levels (0.05 g/dL [0.5 g/L]) is also preferred.

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