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Cited by 603Syphilis Diagnosis and TreatmentBacterial Infections and VaccinesInfectious Diseases and Tuberculosis

Invasion of the Central Nervous System by Treponema pallidum: Implications for Diagnosis and Treatment

Lukehart, Sheila A., Hook, Edward W., Baker-Zander, Sharon A., Collier, Ann C., Critchlow, Cathy W., Handsfield, H. Hunter·1988·Annals of Internal Medicine
DOI 10.7326/0003-4819-109-11-855
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Abstract

STUDY OBJECTIVES: To determine the prevalence of Treponema pallidum in cerebrospinal fluid (CSF) of patients with syphilis, to determine the effect of concurrent HIV infection on central nervous system involvement by T. pallidum, and to examine the efficacy of conventional therapy for asymptomatic neurologic involvement. PATIENTS: Fifty-eight patients with untreated syphilis who consented to lumbar puncture, representing approximately 10% of new cases of syphilis during the study period. INTERVENTIONS: Lumbar puncture was done on all patients. Rabbit inoculation was used to test cerebrospinal fluid for viable T. pallidum. Patients with normal fluid received recommended benzathine penicillin therapy according to the stage of syphilis; patients with CSF abnormalities were offered 10-day therapy for neurosyphilis. RESULTS: Treponema pallidum was isolated from the CSF of 12 (30%) of 40 patients (95% CI, 17 to 46) with untreated primary and secondary syphilis; isolation of T. pallidum was significantly associated (P = 0.008) with the presence of two or more abnormal laboratory variables (among leukocyte count, protein concentration, and CSF-Venereal Disease Research Laboratory [VDRL] test). Two (67%) of 3 early latent (CI, 13 to 100) and 3 (20%) of 15 late latent syphilis patients (CI, 5 to 47) also had reactive CSF-VDRL tests and elevated cell and protein levels, although T. pallidum was not isolated. Concurrent infection with the human immunodeficiency virus (HIV) was not associated with isolation of T. pallidum, increased number of CSF abnormalities, or reactive CSF serologic tests for syphilis, although CSF pleocytosis was commoner in subjects infected with HIV. Treatment with conventional benzathine penicillin G (2.4 mIU) failed to cure 3 of 4 patients with secondary syphilis from whom T. pallidum was isolated before therapy; all 3 patients in whom treatment failed were HIV seropositive when treated or seroconverted during follow-up. CONCLUSIONS: Central nervous system invasion by T. pallidum is common in early syphilis, and is apparently independent of HIV infection. Examination of the CSF may be beneficial in patients with early syphilis, and therapy should be guided by knowledge of central nervous system involvement. Conventional benzathine penicillin G therapy may have reduced efficacy in patients with early syphilis who are also infected with HIV.

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  • Invasion of CSF by T. pallidum accompanied by CSF laboratory abnormalities is common among adults who have primary or secondary syphilis, but its medical significance is unknown.

    “Invasion of CSF by T. pallidum accompanied by CSF laboratory abnormalities is common among adults who have primary or secondary syphilis but has unknown medical significance (585).”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [585]

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Authors
Lukehart, S. A., Hook, E. W., Baker-Zander, S. A., Collier, A. C., Critchlow, C. W., & Handsfield, H. H.
Affiliations
University of Washington (US)
ORCID
Venue
Annals of Internal Medicine
Publisher
American College of Physicians
Published
1988-12-01
Volume
109
Issue
11
Pages
855-862
ISSN
  • 0003-4819 (ISSN-L)
  • 1539-3704
DOI
10.7326/0003-4819-109-11-855
OpenAlex
W2056330847
Cited by
603
References
41
Citations by year
2026: 14 · 2025: 13 · 2024: 16 · 2023: 16 · 2022: 16 · 2021: 8 · 2020: 24 · 2019: 14 · 2018: 22 · 2017: 21 · 2016: 18 · 2015: 22 · 2014: 22 · 2013: 19 · 2012: 21
FWCI
19.53
Type
journal article
Language
en
Open access
closed
Licence
www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations
  • Annals of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institute of Allergy and Infectious Diseases (AI-12192, AI 18988)
  • National Institute of Neurological Disorders and Stroke (NS-23677)
Topics
  • Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
  • Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
  • Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
Keywords
Treponema pallidum, neurosyphilis, untreated syphilis, cerebrospinal fluid, HIV coinfection, cerebrospinal fluid pleocytosis, benzathine penicillin G, treatment failure, early latent syphilis, secondary syphilis
MeSH terms
Adult, Aged, Animals, Cerebrospinal Fluid, Cerebrospinal Fluid Proteins, Female, HIV Seropositivity, Humans, Leukocyte Count, Male, Middle Aged, Neurosyphilis, Penicillin G Benzathine, Prospective Studies, Rabbits, Syphilis, Syphilis Serodiagnosis, Treponema pallidum

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