Diagnosis and management

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The clinical picture of neurosyphilis is so variable that routine serological testing upon admission to psychiatric inpatient units has been recommended. In clinical practice, a rise in atypical syndromes with minor symptomatology has been attributed to partial suppression of the infection during its early stages by antibiotics taken for other reasons/16 The diagnosis of neurosyphilis should be considered on the basis of the patient's symptoms and clinical signs, and confirmed by serology and analysis of the cerebrospinal fluid.

Penicillin is the drug of choice for T. pallidum infections, and in the treatment of neurosyphilis, but the dosage must achieve treponemicidal levels within the cerebrospinal fluid. In untreated cases, death usually occurs within 4 to 5 years. If treatment is given early, the condition usually remits; in already established cases, the progression of the disease can be halted.

Antipsychotics are indicated for the symptomatic management of the excitement and psychotic symptoms that these patients may present. Other sexually transmitted diseases

A diverse range of psychological symptomatology is associated with STDs, in which maladaptive or pathological responses to infection (or fear of infection) may occur. Most of the studies that evaluated the psychological effects of having a STD have been carried out in patients attending genitourinary clinics, and focused on genital herpes, a common, recurrent, and painful infection. The response to diagnosis of a STD can include depression, anxiety, anger, social withdrawal, feelings of loneliness, and sexual dysfunction. (1Z,!8) Also, high rates of hypochondriasis and veneroneurosis (a strong but unfounded conviction of having a venereal disease) are found in STD clinics and are frequently associated with psychiatric morbidity. Psychological interventions can effectively reduce the distress associated with STDs, contribute to the control of the infection, increase compliance with medication regimes, and reduce somatic symptoms misattributed to a STD.

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