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Neurosyphilis: How Do You Know, and What Do You Do?

About 8 years ago, Hector was diagnosed with and treated for syphilis. Two years later, he presented with fever and a diffuse papulosquamous eruption after an unprotected sexual contact. His RPR rose to 1:128. He was treated for presumed secondary syphilis. His symptoms resolved, but he began to complain of more frequent headaches. Two years ago, he again developed fever, and papulosquamous eruption localized to his left arm; his RPR rose to 1:128. He was treated again for secondary syphilis. During the past year, Hector's RPR has remained quite elevated, and he still has frequent severe headaches.