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Argyll Robertson Pupils — SCE Neurology MCQ

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HardCNS InfectionsArgyll Robertson PupilsSCE Neurology

A patient with meningovascular neurosyphilis is clinically stable and can attend daily ambulatory treatment. There is no penicillin allergy. Which BASHH-supported regimen is an appropriate alternative to continuous inpatient intravenous therapy?

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Correct answer: D — Procaine penicillin 1.8–2.4 million units IM daily plus probenecid 500 mg QDS for 14 days

BASHH lists daily intramuscular procaine penicillin with oral probenecid for 14 days as a neurosyphilis regimen, providing sustained treponemicidal penicillin exposure without continuous inpatient intravenous treatment. Benzathine penicillin does not achieve reliable cerebrospinal-fluid concentrations and is used for other syphilis stages, not as sole neurosyphilis therapy. The doxycycline, ceftriaxone and amoxicillin regimens shown are inadequate in dose, duration or evidence. Intravenous benzylpenicillin for 14 days is another recognised regimen when ambulatory treatment is unsuitable.

Reference: BASHH Syphilis 2024 updated guideline: https://www.bashh.org/resources/25/guidelines_syphilis_2024_updated_guideline