What are the treatment methods for neurosyphilis? Five treatment methods for neurosyphilis

Neurosyphilis is a disease caused by nervous system infections, which can be divided into congenital and acquired syphilis. So, what are the treatment methods for neurosyphilis?

Penicillin is used to treat various types of neurosyphilis, with a minimum serum concentration of 0.03 μ G/ml, with a maximum therapeutic serum concentration of 0.1 μ G/ml. It is generally believed that its therapeutic effect is related to the duration of the disease, but not to the dosage of penicillin.

1. Dose and usage of penicillin

There are currently two options for the use of penicillin in the treatment of neurosyphilis both domestically and internationally.

(1) Water soluble Procaine penicillin (Procaine penicillin) G) 900000 U, intramuscular injection once, 15-20 days in total.

(2) Naproxacin penicillin G) 2.4 million U, injected into the muscle once a week for a total of 3 weeks. Some authors believe that the above dose failed to increase the white blood cells in the cerebrospinal fluid and return to normal, or that the toxicity of treponema pallidum in the tissue is very strong, and advocate the use of large doses such as Procaine penicillin, which is injected into the muscle every 12 hours, 600000 yuan U, a total of 15-20 days, and the total amount of more than 20 million U is appropriate.

In 1998, the Centers for Disease Control and Prevention in the United States recommended penicillin for the treatment of neurosyphilis: ① water-soluble crystalline penicillin G, 2-4 million U, intravenous drip, once every 4 hours, for a total of 10-14 days; ② 2.4 million Procaine penicillin U, intramuscular injection once/day, and oral probenecid 500mg, 4 times/day, for 10-14 days.

Other scholars believe that Benzathine penicillin can continue to be injected intramuscularly (Benzathine penicillin G) 2.4 million U once a week for a total of 3 weeks after the above treatment, and the therapeutic effect may be better.

All patients receiving treatment should be regularly tracked and observed. Generally speaking, within the first year after treatment, a follow-up examination is conducted every three months, including a serum syphilis test. If the recovery is good, a re examination will be conducted every six months to one year. Cerebrospinal fluid examination is usually conducted every six months to one year until the cerebrospinal fluid and serum return to normal. Patients are usually followed up for at least three years.

2. Retreatment issues

In the follow-up observation after treatment, if it is found that the last treatment failed, further treatment should be considered. The main manifestation of treatment failure is that the neurosyphilis infection is still active. If clinical symptoms continue to develop, the number of cerebrospinal fluid cells still increases after treatment; After 6 months of treatment, the number of cerebrospinal fluid cells has not yet returned to normal; If the VDRL titer of serum or cerebrospinal fluid does not decrease or increase, further treatment should be given..