What is the first line treatment for Neurosyphilis?

Neurosyphilis, which is a manifestation of syphilis that affects the central nervous system, is effectively treated with Aqueous Crystalline Penicillin G. This formulation of penicillin is chosen due to its ability to achieve high levels in the central nervous system, which is essential for eradicating Treponema pallidum, the bacterium responsible for syphilis. Aqueous Crystalline Penicillin G is administered intravenously, enabling rapid distribution and penetration into the neurovascular barrier, thus ensuring therapeutic concentrations are reached in the brain and cerebrospinal fluid.

While Penicillin G Benzathine is effective for treating primary, secondary, and early latent syphilis due to its long-acting formulation, it is not suitable for neurosyphilis, as it does not achieve the necessary concentrations in the CNS. Clindamycin and Azithromycin are not appropriate choices either, as they are not considered first-line treatments for syphilis and lack efficacy against Treponema pallidum in this context.