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neuropathy or neurosyphilis?
Sep 24, 2007

Hi Doc., My name is Nick and Ive been positive 6 years now. I am taking Combivir and Sustiva since the beginning (no drugs change) and my labs are good: CD4 840; viremy undetectable; all other labs OK. Two years ago, during a routine check, I tested positive to syphilis (previously all negative) with VDRL negative, TPHA 1:5120, FTA Abs IgG 1:20. No symptoms. I was treated with three shots of penicillin for one week and later the tests were VDRL neg., TPHA 1:5120, FTA Abs IgG 1:80. The doctors said that the cure was successful. However, shortly after that (that is about a year ago) I started to have several neurological problems, like tremors and muscle spasms, tingling sensation in arms and legs, excruciating pain in the chest, back and neck, and lately also buzz sounds in my ears, accompanied with increasing depression, anxiety and several panic attacks. Exams excluded any cardiovascular problems. I was diagnosed with peripheral neuropathy mainly due to psychological disorder (depression) The doctors excluded neuro-syphilis, although the did not want to perform any CSF fluid analysis. I am now under psychotherapy and taking also Pregabalin. My questions are: 1) can we really exclude neuro-syphilis? 2) are there any know interactions with my current therapy and Pregabalin? 3) is there any real cure for neuropathy? Thank you for your help and clarifications

Response from Dr. Henry

Often a CSF analysis is necessary to fully evaluate for neurosyphilis. The evolution of your syphilis serologies would be worth tracking to gain a sense of the adequacy of your earlier treatment. Usually Combivir/Sustiva is OK to take with Pregabalin (Lyrica). Neuropathy can be very frustrating to optimally diagnose and manage. The 3TC in Combivir can occasionally aggravate the problem when particularly when more localized to feet/toes.



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