Would you repeat a course of penicillin in a patient with suspected syphilitic chorioretinitis who was previously treated with 14 days of IV penicillin after concurrent diagnosis of meningovascular syphilis with initial RPR >1:256 and new HIV with CD4 200 and viral load 210,000, now with RPR 1:32, CD4 340 and viral load undetectable on antiretrovirals, negative interferon gamma release assay, and who denies new sexual exposures?

Patient is a male in his 30s. On initial presentation, had acute CVA of left MCA. RPR >1:256, CSF VRDL+ with total nucleated cells 379-400, 89% lymphocytes, protein 22, glucose 42; CD4 absolute count 200, 7% and viral load 210,000. Started on BIC-FTC-TAF, given 14 days of IV penicillin. Five months later, RPR was 1:128. Now 8 months after initial presentation, RPR 1:32 and CD4 341/15% with undetectable viral load. Referred to ophthalmology for incidental optic disc edema and was found to have bilateral placoid retinal lesions that have persisted despite prolonged prednisone taper over several weeks. Their primary differential includes tuberculosis and syphilis.