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February 1986

Lumbar Puncture in the Treatment of Neurosyphilis-Reply

Arch Intern Med. 1986;146(2):412. doi:10.1001/archinte.1986.00360140268041

Dr Wolters' finding of such a high proportion (23%) of neurosyphilis among those with asymptomatic late syphilis is notable. This is higher than other studies, even those performed prior to the widespread use of antibiotic therapy, which generally found the proportion to be around 10%. Based on studies performed in this country after the introduction of antibiotics, we estimate this proportion to be less than 5%. The difference in Dr Wolters' study and the current estimate may be one of definition. The studies on which we based current estimates did not include people with dizziness or headaches. If Dr Wolter's population truly has such a high prevalence, then a routine cerebrospinal fluid (CSF) examination should be performed.

The antibody test used by Dr Wolters is not available to most physicians. Furthermore, CSF treponemal antibody tests have low specificity; therefore, only reagin tests are used for CSF analysis in this country.1