Neurosyphilis with optic neuritis: an update

There is currently a resurgence of infectious syphilis in the UK (http://www.hpa.co.uk) and the rate remains high in the USA (http://www.cdc.gov/std) and in the Russian Federation states.1 In the past the protean manifestations of syphilis earned it the title of “the great imitator”. The high prevalence of syphilis before, and during, the second world war meant that it always featured highly in the differential diagnosis of any ophthalmic problem. Antibiotic treatment has reduced the prevalence to the extent that it is seldom considered first nowadays.2 The interaction of syphilis and HIV has stimulated renewed interest in this ancient disease and has challenged some of the long held ideas about the investigation and treatment of syphilis. A case of secondary syphilis is presented in which a sudden loss of vision occurred despite initial treatment with benzathine penicillin and doxycyline with corticosteroid cover. The natural history, investigation, treatment and follow up for neurosyphilis are discussed.