Otosyphilis Treatment — SCE Infectious Diseases MCQ

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HardSTIsOtosyphilis TreatmentSCE Infectious Diseases

A 35-year-old man with HIV on ART develops syphilitic otitis (sudden sensorineural hearing loss with positive syphilis serology, RPR 1:64). He has no other neurological symptoms. What treatment is required?

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Correct answer: B — IV Benzylpenicillin 18–24 MU daily for 14 days

Otosyphilis (and ocular syphilis) are now recognised as forms of neurosyphilis requiring IV Benzylpenicillin treatment REGARDLESS of CSF findings. Even if LP is normal, otic and ocular syphilis must be treated with the neurosyphilis regimen: IV Benzylpenicillin 18–24 MU daily (3–4 MU every 4 hours) for 14 days. Intramuscular Benzathine Penicillin achieves inadequate CSF/perilymph levels. Syphilitic hearing loss may be partially or fully reversible with prompt treatment. BASHH 2019 guidelines emphasise this point.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/infections