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February 1986

Lumbar Puncture in Late Syphilis

Arch Intern Med. 1986;146(2):408-409. doi:10.1001/archinte.1986.00360140260039

To the Editor.  —In the March 1985 Archives, Wiesel et al1 evaluated the treatment of asymptomatic late syphilis patients with and without differentiation of asymptomatic neurosyphilis, based on cerebrospinal fluid analysis. The conclusion was that lumbar puncture (LP) offers little additional benefit and may increase morbidity in patients with asymptomatic late syphilis.The following comment on Wiesel's article can be made: Detecting a specific antitreponemal immune response in the central nervous system is sufficient evidence for the presence of asymptomatic neurosyphilis. The needed immunologic parameters have recently been developed and published.2-5To obtain more information about the cerebrospinal fluid pattern in asymptomatic late syphilis, LPs were performed in 194 patients: 96 penicillin-treated (one year after the administration of one to three doses of 2.4 million units of penicillin G benzathine) and 98 untreated. In eight of the treated and eight of the untreated patients, we found evidence