Syphilis is a mandatory reportable disease in all jurisdictions
Partner notification essential — sexual contacts within 12 months should be tested and treated
Pre-exposure counselling on safe sexual practices
Patient Discharge Instructions
copy discharge instructions
Diagnosis explanation
You have been assessed for Argyll Robertson pupil — a condition where your pupils do not respond normally to light
This finding is most commonly caused by syphilis affecting the nervous system (neurosyphilis)
Further testing is needed to confirm the cause and begin treatment
Medication instructions
If neurosyphilis is confirmed, treatment requires IV penicillin given in hospital for 10–14 days
Complete the full course of antibiotics — stopping early may result in treatment failure
You may experience fever, chills, and rash within the first 24 hours of treatment (Jarisch-Herxheimer reaction) — this is expected; take paracetamol and drink fluids
Activity and follow-up
Attend all scheduled blood test and clinic appointments
Repeat blood tests are required at 3, 6, 9, 12, and 24 months after treatment
A repeat spinal fluid test (lumbar puncture) will be arranged at 6 months
Ophthalmology and neurology follow-up appointments as arranged
Partner notification
Syphilis is a sexually transmitted infection — your sexual partners need to be tested and treated
Public health will contact you to assist with partner notification
Use condoms consistently during and after treatment
Return to emergency department immediately if
New or worsening vision loss
New hearing loss or vertigo
Worsening headache, confusion, or personality changes
New weakness, numbness, or difficulty walking
High fever or rash after starting antibiotics
Seizure or loss of consciousness
Expected course
Your pupil abnormality may persist even after successful treatment — this does not mean treatment has failed
Neurologic symptoms may stabilize but advanced damage may not fully reverse
Syphilis can be cured — early and complete treatment gives the best outcome
References
Guidelines and key sources
Ropper AH. Neurosyphilis. New England Journal of Medicine 2019
Comprehensive review of neurosyphilis diagnosis and IV penicillin G treatment regimen
NEJM 2019; 381:1358–1363
Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines 2021
CDC MMWR 2021 — definitive US treatment guidelines for neurosyphilis
Recommends IV crystalline penicillin G 18–24 million units/day for 10–14 days
PMCID: PMC8344968
Hamill MM, Ghanem KG, Tuddenham S. State-of-the-Art Review: Neurosyphilis
Clinical Infectious Diseases 2024 — contemporary epidemiology and management
PMID: 37593890
Thompson HS, Kardon RH. The Argyll Robertson Pupil
Journal of Neuro-Ophthalmology 2006 — seminal review of AR pupil pathophysiology and differential
PMID: 16845316
Dacso CC, Bortz DL. Significance of the Argyll Robertson Pupil in Clinical Medicine
American Journal of Medicine 1989 — clinical review of AR pupil and neurosyphilis correlation
PMID: 2643871
Supporting references
Chevalier FJ, Bacon O, Johnson KA, Cohen SE. Syphilis. JAMA 2025
Contemporary clinical overview of syphilis diagnosis and management
Miller NR, Newman NJ. The Eye in Neurological Disease. Lancet 2004
Neuro-ophthalmologic conditions including AR pupil differential diagnosis
PMID: 15582062
Tuddenham S, Hamill MM, Ghanem KG. Diagnosis and Treatment of Sexually Transmitted Infections: A Review. JAMA 2022
Systematic review of STI management including syphilis
Lisowski et al. The Diagnostic Significance of Pupillary Reflex Pathways. Frontiers in Neuroscience 2025
Pupillometry and pupillary reflex pathway review
PMID: 41169745
Xu SY et al. Adie's Pupil: A Diagnostic Challenge for the Physician. Medical Science Monitor 2022
Key reference for distinguishing Adie tonic pupil from AR pupil
PMID: 35304432
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.