Final answer:
HIV infected patients with neurologic symptoms and syphilis require extensive diagnostic evaluation, including cerebrospinal fluid assessment, before starting treatment. VDRL-CSF testing is crucial although not solely sufficient for neurosyphilis diagnosis. The treatment typically involves parenteral penicillin G, with careful monitoring in cases where alternative antibiotics are used due to penicillin allergy.
Step-by-step explanation:
HIV Infected Patients with Neurologic Symptoms and Syphilis
HIV infected patients presenting with neurologic symptoms suggestive of neurosyphilis, such as headache, forgetfulness, and visual changes, should be thoroughly evaluated before beginning treatment. These patients, especially those with syphilis of unknown duration or late latent syphilis, which is acquired more than a year earlier, require specific diagnostic testing.
To diagnose neurosyphilis, it is not sufficient to rely on a single test. Instead, an array of diagnostic criteria must be assessed, including reactive serologic tests, abnormalities in cerebrospinal fluid cell count, cerebrospinal fluid protein abnormalities, or a reactive VDRL-CSF, which is a syphilis test done on cerebrospinal fluid. While the VDRL-CSF is highly specific, it is not sensitive enough by itself to be conclusive in the diagnosis of neurosyphilis.
The recommended treatment for syphilis is parenteral penicillin G, particularly long-acting benzathine penicillin, which depends on the stage of the disease. For patients with late latent syphilis or tertiary syphilis, three doses of penicillin administered at weekly intervals are usually necessary for a cure. If the patient is allergic to penicillin, alternative antibiotics may be used, but these cases require close follow-up to ensure successful treatment.
Therefore, for HIV infected patients displaying symptoms of neurosyphilis, a comprehensive evaluation including specific diagnostic tests of the cerebrospinal fluid must be conducted before administering the appropriate antibiotic therapy to ensure the best possible treatment outcome.