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Cited by 159Syphilis Diagnosis and TreatmentBacterial Infections and VaccinesHistorical Medical Research and Treatments

Normalization of serum rapid plasma reagin titer predicts normalization of cerebrospinal fluid and clinical abnormalities after treatment of neurosyphilis.

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Marra, Christina M., Maxwell, Clare L., Tantalo, Lauren C., Sahi, Sharon K., Lukehart, Sheila A.·2008·Clinical Infectious Diseases
DOI 10.1086/591534PMC PMC2729357
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Abstract

BACKGROUND: Success of neurosyphilis treatment is defined by normalization of cerebrospinal fluid (CSF) and clinical abnormalities. The goal of this study was to determine whether normalization of serum rapid plasma reagin (RPR) titer could accurately predict treatment success. METHODS: One hundred ten patients who were enrolled in a longitudinal study of CSF abnormalities in syphilis had asymptomatic syphilitic meningitis, symptomatic syphilitic meningitis, or syphilitic eye disease and were treated for neurosyphilis. At 4, 7, and 13 months after treatment, serum RPR titer and CSF and clinical abnormalities were analyzed for normalization. Odds ratios for normalization of each CSF and clinical abnormality when serum RPR titer had normalized and the positive predictive value of normalization of serum RPR titer for normalization of CSF and clinical abnormalities were determined. RESULTS: Serum RPR titer had normalized in 63 patients (57%) by 4 months after treatment, in 94 (85%) by 7 months, and in 97 (88%) by 13 months. Except for CSF protein concentration, normalization of serum RPR titer predicted normalization of other CSF and clinical abnormalities in >80% of patients at 4 months, >85% at 7 months, and >90% at 13 months. The odds of normalization of CSF and clinical abnormalities were 28-57-fold higher when serum RPR titer had normalized, compared with when it had not. Normalization of serum RPR titer was consistently less accurate in predicting treatment success in human immunodeficiency virus-infected patients who were not receiving antiretroviral therapy, compared with those who were receiving such therapy. CONCLUSIONS: In most instances, normalization of serum RPR titer correctly predicts success of treatment of neurosyphilis, and follow-up lumbar puncture can be avoided.

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  • Among immunocompetent persons and persons with HIV infection on effective ART, normalization of serum RPR titer predicts normalization of abnormal CSF parameters after neurosyphilis treatment.

    “Data from two studies indicate that, among immunocompetent persons and persons with HIV infection who are on effective ART, normalization of the serum RPR titer predicts normalization of abnormal CSF parameters after neurosyphilis treatment (614,615).”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [614]

    The Discussion reports that serum RPR normalization is a good predictor of CSF normalization after neurosyphilis treatment and that prediction is more accurate in HIV-infected patients receiving ART than in those not receiving it. The paper distinguishes ART use, not whether ART was effective; its Results also find prediction less accurate for CSF protein than for other CSF measures. No page numbers were available in our copy. (LLM, conf=0.84)

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  • Among persons with HIV infection and syphilis, CSF abnormalities are associated with a CD4+ T-cell count of ≤350 cells/mL or an RPR titer of ≥1:32.

    “Certain studies have demonstrated that among persons with HIV infection and syphilis, CSF abnormalities are associated with a CD4+ T-cell count of ≤350 cells/mL or an RPR titer of ≥1:32 (614,627).”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [614]

    The Results section (Normalization of CSF WBC count; page unavailable) links pretreatment RPR ≥1:32 to lower odds that a CSF abnormality will normalize after neurosyphilis treatment. That is not the claimed association with the presence of CSF abnormalities among people with HIV and syphilis. The Methods section (Laboratory measures; page unavailable) says CD4 counts were measured, but the passages found do not establish an association at ≤350 cells/mL. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • Limited data suggest that routine CSF measurement can be avoided in patients with satisfactory reduction of serum RPR titres.

    “Limited data suggest that routine CSF measurement can be avoided in patients with satisfactory reduction of serum RPR titres.37,126”

    From BASHH UK guidelines for the management of syphilis 2024 (2024) · cites this paper as [126]

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Research works printed but not linked: 1

  1. [13]Centers for Disease Control and Prevention Symptomatic early neurosyphilis among HIV-positive men who have sex with men—four cities, United States, January 2002–June 2004 MMWR Morb Mortal Wkly Rep 2007 56 625 628 17597693 PMC6818090

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Authors
Marra, C. M., Maxwell, C. L., Tantalo, L. C., Sahi, S. K., & Lukehart, S. A.
Affiliations
University of Washington (US)
Corresponding author
Marra, Christina M.
ORCID
Venue
Clinical Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2008-10
Volume
47
Issue
7
Pages
893-899
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
DOI
10.1086/591534
PMC
PMC2729357
OpenAlex
W2120399421
Cited by
159
References
12
Citations by year
2026: 7 · 2025: 10 · 2024: 8 · 2023: 9 · 2022: 11 · 2021: 11 · 2020: 9 · 2019: 6 · 2018: 7 · 2017: 7 · 2016: 6 · 2015: 16 · 2014: 3 · 2013: 8 · 2012: 6
FWCI
7.67
Type
journal article
Language
en
Open access
Locations
  • Clinical Infectious Diseases (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Neurological Disorders and Stroke (NS 34235, R01NS034235)
Topics
  • Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
  • Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Historical Medical Research and Treatments
Keywords
neurosyphilis, treatment response prediction, cerebrospinal fluid abnormalities, syphilitic meningitis, HIV coinfection, antiretroviral therapy, CSF protein concentration
MeSH terms
Adult, Cardiolipins, Cholesterol, Female, Humans, Longitudinal Studies, Male, Neurosyphilis, Phosphatidylcholines, Reagins, Syphilis Serodiagnosis, HIV Infections

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