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Article
February 1986

Lumbar Puncture in Late Syphilis

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

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

References
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Wiesel J, Rose DN, Silver AL, et al:  Lumbar puncture in asymptomatic late syphilis: An analysis of the benefits and risks.  Arch Intern Med 1985;145:465-468.Crossref
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Stockli HR:  Neurosyphilis heute.  Dermatologica 1982;165:232-248.Crossref
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Vartdal F, Sandvik B, Michaelsen TE, et al:  Neurosyphilis: Intrathecal synthesis of oligoclonal antibodies to Treponema pallidum.  Ann Neurol 1982;11:35-40.Crossref
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Muller F, Moskophidis M:  Estimation of the local production of antibodies to Treponema pallidum in the central nervous system of patients with neurosyphilis.  Br J Vener Dis 1983;59:80-84.
5.
Prange HW, Moskophidis M, Schipper HI, et al:  Relationships between neurological features and intrathecal synthesis of IgG antibodies to Treponema pallidum in untreated and treated human neurosyphilis.  J Neurol 1983;230:241-252.Crossref
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Tourtelotte WW, Henderson WG, Tucker RP, et al:  Randomized double-blind clinical trial comparing the 22- versus 26-gauge needle in the production of the post-lumbar puncture syndrome in normal individuals.  Headache 1972;12: 73-78.Crossref
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