Ceftriaxone Treatment for Two Neurosyphilis Cases Presenting with Cognitive and Psychiatric Symptoms

Abstract

Syphilis is a disease caused by the spirochetal bacterium Treponema pallidum subspecies pallidum. The route of transmission of syphilis is almost always through sexual contact. The incidence of syphilis decreased significantly with the introduction of penicillin in the 1940s but rose sharply again with the advent of human immunodeficiency virus (HIV) infection in the 1980s. Tertiary or late syphilis develops years after the initial infection and can involve any organ system. Neurologic involvement occurs in up to 10% of patients with untreated syphilis. General paresis, the clinical form of neurosyphilis most associated with psychiatric symptoms, occurs with parenchymatous disease and involves neuronal loss as opposed to the vascular lesions or inflammatory changes characteristic of most other forms of neurosyphilis. In the classic description, after early psychiatric manifestations such as mood changes, psychosis or cognitive changes, dementia becomes prominent. Penicillin is the only drug that has proved effective in the treatment of neurosyphilis. Ceftriaxone is used as an alternative treatment in patients with penicillin allergy. This article reports two cases of neurosyphilis, one of whom presented with dementia and the other with psychiatric symptoms. Both of them were treated with ceftriaxone. Our purpose is to highlight the fact that ceftriaxone is a successful alternative treatment for cases with penicillin allergy and to emphasize the importance of neurosyphilis in the differential diagnosis in psychiatric cases that are resistant to treatment.