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August 7, 1995

Lumbar Puncture for Evaluation of Latent Syphilis in Hospitalized Patients: High Prevalence of Cerebrospinal Fluid Abnormalities Unrelated to Syphilis

Author Affiliations

From the Department of Oncology (Dr Carey) and Divisions of Infectious Diseases (Drs Glesby and Mundy) and Cardiology (Dr Janis), Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md; and Division of Infectious Diseases, University of Alabama at Birmingham (Dr Hook).

Arch Intern Med. 1995;155(15):1657-1662. doi:10.1001/archinte.1995.00430150145015

Objective:  To determine the prevalence of abnormal neurologic findings and cerebrospinal fluid abnormalities in hospitalized patients with serologic evidence of latent syphilis.

Design:  Cross-sectional survey.

Methods:  Consecutively admitted hospital inpatients from an inner-city population were screened for serologic evidence of syphilis with reactive plasma reagin and confirmatory fluorescent treponemal antibody absorption assays. In those with reactive tests, such clinical findings as a history of treatment for syphilis, neurologic abnormalities, presence of human immunodeficiency virus infection, and rapid plasma reagin titer were correlated with cerebrospinal fluid white blood cell count, protein level, and VDRL result.

Results:  Of 490 consecutive patients, 52 (11%) had serologic evidence of syphilis. Forty-three (83%) of these underwent lumbar puncture. Of the 43, 31 (72%) were seronegative for human immunodeficiency virus and 12 (28%) were seropositive. No patient had a reactive cerebrospinal fluid VDRL test. Cerebrospinal fluid abnormalities were seen in 32% of human immunodeficiency virus—seronegative patients and in 67% of human immunodeficiency virus—seropostive patients. Cerebrospinal fluid abnormalities were not predicted by history of treatment for syphilis, abnormal neurologic findings, or an elevated rapid plasma reagin titer. Cerebrospinal fluid IgG indexes in patients with elevated cerebrospinal fluid protein levels suggested that the protein abnormalities were not caused by local antibody production. Nonreactive cerebrospinal fluid fluorescent treponemal antibody absorption tests suggest that the cerebrospinal fluid abnormalities were not the result of neurosyphilis.

Conclusions:  There was a high prevalence of cerebrospinal fluid abnormalities in hospitalized patients with latent syphilis detected by routine screening. Because of the nonspecificity of the cerebrospinal fluid findings, routine lumbar puncture for such patients appears to contribute little to the treatment of latent syphilis.(Arch Intern Med. 1995;155:1657-1662)

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