More on Diagnosing Neurosyphilis in HIV-Infected Patients

When it comes to pursuing a diagnosis of asymptomatic neurosyphilis (ANS) in HIV-infected patients, the experts have pretty much agreed to disagree. The most recent CDC guidelines recommend spinal fluid analysis for HIV-infected patients who have late latent syphilis, syphilis of unknown duration, or serologic failure after a course of syphilis treatment. Other authorities suggest that spinal fluid should be obtained in individuals with CD4 counts ≤350 cells/mm³ or rapid plasma reagin (RPR) titers ≥1:32. To determine which nomogram might yield an ANS diagnosis most efficiently, investigators reviewed data from a large cohort of HIV-infected patients at the Johns Hopkins Moore Clinic.

During the 17-year study period, 231 episodes of syphilis …