When Should You Look for Neurosyphilis?

Controversy has dogged efforts to construct algorithms for diagnosing and treating neurosyphilis in HIV-infected patients. Some experts endorse looking for neurosyphilis with a lumbar puncture in all HIV-coinfected patients with syphilis, whereas others recommend that this procedure be reserved for patients with high nontreponemal antibody titers or those who do not respond serologically to standard syphilis treatment.

To study how well neurosyphilis responds to treatment, a national consortium of researchers enrolled subjects with syphilis who met generally accepted criteria for lumbar puncture (e.g., presence of neurologic or ophthalmologic symptoms, treatment failure, or intent to begin non-penicillin therapy). All subjects underwent lumb…