While the course of syphilis can be complicated by involvement of virtually all organ systems, arguably the most difficult forms of complicated syphilis to identify and manage are those that involve the nervous system. In the pre-antibiotic era, all patients with syphilis, regardless of symptoms, underwent a lumbar puncture (LP), and those with cerebrospinal fluid abnormalities received augmented therapy in an effort to prevent subsequent symptomatic neurosyphilis. When penicillin became available, this practice seemed unnecessary. Subsequent reports of symptomatic neurosyphilis after appropriate treatment for early syphilis in persons living with HIV revived LP in neurologically asymptomatic individuals. However, its benefit in terms of morbidity averted is unknown, and recommendations have varied despite lack of data. In this presentation, complicated syphilis is defined as neurosyphilis, ocular syphilis, or otosyphilis. Topics to be discussed include epidemiology, host and bacterial risk factors, screening, the role of LP in management, and treatment.

Disclosure No significant relationships.