Therecent increase on the incidence of syphilis, mainly in the last 15 years withthe emergence of AIDS, seems to lead to the augment of atypical cases observedin the dairy medical practice. The frequency in the co-infection HIV/syphilisamong male homosexuals in larger urban centers varies from 20% to 70%. In thesecases, ulcers are persistent, and the evolution to latter stages occurs in afaster way. Among the most severe complications of the untreated or unsuitabletreated disease, neurosyphilis can develop, provoking several neurological andpsychiatric symptoms and signals, sometimes disabling. Diagnosis can be doneby cerebrospinal fluid (CSF) punction, permitting to evaluate cells number andproteins abnormalities as so treponemal and non-treponemal tests. CSF testsshould be done in all patients with positive serological tests for syphilis,in neurological, ophthalmic, or tertiary disease, or in those who have failedtherapy, and in HIV-infected patients with late latent syphilis or syphilisof unknown duration. However, neurolues is unlikely when serologic VDRL is negative.In those patients, CSF punction is not recommended. But this is reasonable certainlyof neurolues when neuropsychiatric syndromes are present associated to reactiveCSF VDRL.
