       Document 0564
 DOCN  M9640564
 TI    Syphilis. A tale of twisted treponemes.
 DT    9604
 AU    Flores JL; Department of Medicine, Veterans Affairs (VA) Medical Center,
       San; Francisco, CA 94121, USA.
 SO    West J Med. 1995 Dec;163(6):552-9. Unique Identifier : AIDSLINE
       MED/96137732
 AB    Despite the widespread availability of effective treatment, the
       incidence of primary and secondary syphilis in the United States is on
       the rise. In addition, syphilis is occurring in a substantial number of
       patients infected with the human immunodeficiency virus (HIV), thus
       adding to the complexities of diagnosis and treatment. Primary syphilis
       represents a disseminated infection, often accompanied by abnormalities
       of the cerebrospinal fluid, that may pass unrecognized and progress to
       the myriad manifestations of secondary syphilis. The diagnosis of
       syphilis in patients with mucosal or skin lesions may be made by
       darkfield examination; once lesions have resolved, serologic tests are
       required. Patients with latent syphilis may have asymptomatic
       neurosyphilis and risk progression to tertiary disease. The diagnosis of
       asymptomatic neurosyphilis is necessary to determine the optimal
       treatment of patients with latent disease. The diagnosis of active
       neurosyphilis generally requires an inflammatory cerebrospinal fluid
       profile and a reactive cerebrospinal fluid VDRL test. Syphilis is common
       in HIV-infected patients, who may have an altered antibody response to
       infection and an apparent increased incidence of neurologic
       complications. The preferred treatment at all stages is penicillin,
       which is also the only recommended therapy for neurosyphilis. The
       optimal treatment of syphilis in HIV-infected patients is unknown.
 DE    Human  *Syphilis  JOURNAL ARTICLE  REVIEW  REVIEW, TUTORIAL

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