Neurosyphilis is Unlikely in Patients with Late Latent Syphilis and a Negative Blood VDRL-Test
Open accessAbstract
Patients with latent syphilis or syphilis of unknown duration should be evaluated for tertiary disease and neurosyphilis. The aim of this retrospective study was to determine relevant serological parameters for the identification of those individuals with syphilis who are most likely to have neurosyphilis and who therefore require lumbar puncture. After excluding repeated estimates and patients whose blood syphilis serology had either been negative or not been determined within 3 months of lumbar puncture, 265 out of 710 cerebrospinal fluids from 1988 to 2004 were analysed. In each of those patients the earliest available pairs of serum and cerebrospinal fluid samples were evaluated. The diagnosis of neurosyphilis was based on criteria according to established guidelines. Forty-three of 265 patients (16.2%; 5 women, 38 men; mean age 47+/-16 years) had neurosyphilis. Seven of 72 (9.7%) of those testing HIV-positive, fulfilled the criteria of neurosyphilis. Not a single patient with neurosyphilis tested Venereal Disease Research Laboratory test (VDRL)-negative in peripheral blood, an effect which was highly significant (p < 0.01, chi2-test). The median blood-VDRL titre was significantly higher in patients with neurosyphilis than in those without (1:32 vs. 1:0; p < 0.01, t-test, two-sided). Hence, neurosyphilis is very unlikely in patients with a negative blood-VDRL. Therefore, lumbar puncture is not recommended in these patients.
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A serum RPR titre of 1:32 has been demonstrated to be associated with CSF abnormalities similar to those seen in neurosyphilis.
“a serum RPR titre of 1:32 has been demonstrated to be associated with CSF abnormalities similar to those seen in neurosyphilis.63,65”
From BASHH UK guidelines for the management of syphilis 2024 (2024) · cites this paper as [65]
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2014 European guideline on the management of syphilis
Janier, M., Hegyi, V., Dupin, N., Unemo, M., Tiplica, G. S., Potočnik, M., French, P., & Patel, R. (2014) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/jdv.12734 · Cited by 360 · see citing works
Syphilis laboratory guidelines: performance characteristics of nontreponemal antibody tests.
Tuddenham, S., Katz, S. S., & Ghanem, K. G. (2020) · Clinical Infectious Diseases · doi:10.1093/cid/ciaa306 · Cited by 124 · see citing works
Park, I. U., Chow, J. M., Bolan, G., Stanley, M., Shieh, J., & Schapiro, J. M. (2011) · The Journal of Infectious Diseases · doi:10.1093/infdis/jir524 · Cited by 103 · see citing works
BASHH UK guidelines for the management of syphilis 2024
Kingston, M., Apea, V., Evans, C., Fifer, H., Foster, K., Patrick, P., Grant, A., Manns, V., Ramsden, S., Sinka, K., et al. (2024) · International Journal of STD & AIDS · doi:10.1177/09564624241280406 · Cited by 51 · see citing works
- Authors
- Wöhrl, S., & Geusau, A.
- Affiliations
- Medical University of Vienna (AT)
- Venue
- Acta Dermato-Venereologica
- Published
- 2006
- Volume
- 86
- Issue
- 4
- Pages
- 335-339
- ISSN
- 0001-5555 (ISSN-L)
- OpenAlex
- W2153028660
- Cited by
- 45
- References
- 1
- Citations by year
- 2024: 2 · 2023: 1 · 2022: 4 · 2021: 2 · 2020: 2 · 2019: 1 · 2017: 2 · 2016: 1 · 2015: 6 · 2014: 2 · 2013: 2 · 2012: 7
- FWCI
- 1.97
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- Acta Dermato Venereologica (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
- Life Sciences › Immunology and Microbiology › Parasitology › Vector-borne infectious diseases
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Keywords
- neurosyphilis, late latent syphilis, VDRL test, cerebrospinal fluid serology, lumbar puncture, HIV coinfection, syphilis serology, tertiary syphilis, diagnostic criteria
- MeSH terms
- Adult, Aged, Cerebrospinal Fluid, Female, HIV Seropositivity, Humans, Male, Middle Aged, Neurosyphilis, Sensitivity and Specificity, Spinal Puncture, Syphilis Serodiagnosis
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