HIV and syphilis: when to perform a lumbar puncture

• Published in: Sexually transmitted diseases Vol. 34; no. 3; p. 141
• Main Authors: Libois, Agnès, De Wit, Stéphane, Poll, Bénédicte, Garcia, Felipe, Florence, Eric, Del Rio, Ana, Sanchez, Paquita, Negredo, Eugenia, Vandenbruaene, Marc, Gatell, José M, Clumeck, Nathan
• Format: Journal Article
• Language: English
• Published: United States 01.03.2007
• Subjects: Adult; Aged; Female; HIV Infections - complications; Humans; Male; Middle Aged; Neurosyphilis - cerebrospinal fluid; Neurosyphilis - complications; Neurosyphilis - diagnosis; Neurosyphilis - microbiology; Reagins - blood; Risk Factors; ROC Curve; Sensitivity and Specificity; Spinal Puncture; Syphilis - cerebrospinal fluid; Syphilis - complications; Syphilis - microbiology; Treponema pallidum - immunology; Treponema pallidum - isolation & purification
• ISSN: 0148-5717
• DOI: 10.1097/01.olq.0000230481.28936.e5

The objectives of this study were to determine predictive factors for neurosyphilis in HIV-infected patients with syphilis and optimize the use of lumbar puncture. The authors reviewed 112 cases of HIV-infected patients with syphilis who underwent a lumbar puncture. Diagnosis of neurosyphilis was based on a cerebrospinal fluid white blood cells count > or =20/microL, and/or a reactive cerebrospinal fluid-Venereal Disease Research Laboratory, and/or a positive intrathecal T. pallidum antibody (ITPA) index. Twenty-six of 112 had neurosyphilis. Neurologic manifestations and serum rapid plasma reagin (RPR) were associated with neurosyphilis (P = 0.036, P = 0.018, respectively). In multivariate analysis, log(2)RPR was still associated with neurosyphilis (P = 0.005). In patients without neurologic manifestations, the risk of neurosyphilis increases gradually with log(2)RPR. A serum RPR of 1/32 seems to be the best cutoff point to decide the performance or not of a lumbar puncture (sensitivity 100%, specificity 40%). In HIV-infected patients with syphilis, lumbar puncture could be restricted to those with neurologic manifestations or a serum RPR > or =1/32.