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Neurosyphilis tabes dorsalis — SCE Neurology MCQ

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ModerateCNS InfectionsNeurosyphilis tabes dorsalisSCE Neurology

A man has confirmed neurosyphilis with meningitis and cranial neuropathy. He has no history of immediate penicillin hypersensitivity. Which antimicrobial regimen best follows current UK guidance?

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Correct answer: E — Benzylpenicillin 1.8–2.4 g intravenously every four hours for 14 days

Neurosyphilis requires a CNS-penetrating regimen. BASHH recommends benzylpenicillin 1.8–2.4 g intravenously every four hours for 14 days (or procaine penicillin plus probenecid in the specified alternative regimen). A single intramuscular benzathine dose treats early uncomplicated syphilis but is not an adequate neurosyphilis regimen. Short oral regimens are inadequate.

Reference: BASHH UK syphilis guideline 2024: https://www.bashh.org/_userfiles/pages/files/syphilis_2024.pdf?UNLID=712016336202581475056