Acute syphilitic meningitis. Its occurrence after clinical and serologic cure of secondary syphilis with penicillin G.

Acute syphilitic meningitis developed in a 36-year-old man three months after apparently successful treatment of secondary syphilis with doses of penicillin G benzathine recommended by the current Centers for Disease Control guidelines. He was then treated with high-dose intravenous penicillin G sodium, with resolution of symptoms and cerebrospinal fluid abnormalities. Although other instances of neurosyphilis following adequate therapy for early syphilis have been reported, in most cases reinfection cannot be convincingly excluded. We believe this patient represents a particularly well-documented example of progression to neurosyphilis, despite recommended therapy with penicillin. A review of recently reported cases suggests that progression of syphilis, despite "appropriate" therapy, is not an isolated event.