TREPONEMA pallidum, the etiologic agent of syphilis, may be detected in the cerebrospinal fluid during early infection. The recommended therapeutic agent for primary, secondary, and latent syphilis, benzathine penicillin, does not reach treponemicidal levels within the cerebrospinal fluid, and concerns have been raised that current treatment regimens may be inadequate, particularly in patients who harbor spirochetes in their central nervous systems. We report the failure of benzathine penicillin in the treatment of secondary syphilis in a homosexual man who was seropositive for human immunodeficiency virus (HIV). After therapy, his serum Venereal Disease Research Laboratory (VDRL) test titers decreased appropriately….
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