Syphilis, a contagious systemic disease caused by Treponema pallidum, can affect any system in the body. Neurosyphilis can be asymptomatic or symptomatic. As spirochetes affect the central nervous system in 40% of cases of acquired syphilis, Lesser and others (1) have stated that anyone with syphilis may be considered to have neurosyphilis until proved otherwise.

Optic neuropathy is not rare in secondary syphilis. It may be associated with an anterior uveitis and vitritis. Syphilitic ocular findings have been associated with the secondary stage of the disease where hematogenous dissemination of the spirochete occurs. Ocular involvement strongly suggests central nervous system disease involvement, and some feel that it may be synonymous with neurosyphilis. Laboratory examination of the cerebrospinal fluid invariably reveals a reactive VDRL in these cases. Traditionally, patients who develop clinical neurosyphilis will present first with acute meningitis or meningovascular signs and/or symptoms. However, patients with ocular syphilis present with minimal or with no signs of meningoencephalitic changes.

After proper treatment (currently 12-24 million units of intravenous penicilin daily for about 2 weeks followed by oral penicillin), quantitative reagin tests should be performed at 1, 3, 6, and 12 months or until no reaction is found, whichever period is longer. CSF study should be repeated at the end of the 1-year surveillance. If all clinical and serologic examinations remain satisfactory for 2 years, cure is complete and no further follow-up is needed.