Cerebrospinal Fluid Abnormalities in Patients with Syphilis: Association with Clinical and Laboratory Features

Christina M. Marra, Clare L. Maxwell, Stacy L. Smith, Sheila A. Lukehart, Anne M. Rompalo, Molly Eaton, Bradley P. Stoner, Michael Augenbraun, David E. Barker, James J. Corbett, Mark Zajackowski, Charles Raines, Judith Nerad, Romina Kee, Scott H. Barnett

Research output: Contribution to journalArticlepeer-review


Objective. To define clinical and laboratory features that identify patients with neurosyphilis. Methods. Subjects (n = 326) with syphilis but no previous neurosyphilis who met 1993 Centers for Disease Control and Prevention criteria for lumbar puncture underwent standardized history, neurological examination, venipuncture, and lumbar puncture. Neurosyphilis was defined as a cerebrospinal fluid (CSF) white blood cell count >20 cells/μL or reactive CSF Venereal Disease Research Laboratory (VDRL) test result. Results. Sixty-five subjects (20.1%) had neurosyphilis. Early syphilis increased the odds of neurosyphilis in univariate but not multivariate analyses. In multivariate analyses, serum rapid plasma reagin (RPR) titer ≥1:32 increased the odds of neurosyphilis 10.85-fold in human immunodeficiency virus (HIV)-uninfected subjects and 5.98-fold in HIV-infected subjects. A peripheral blood CD4+ T cell count ≤350 cells/μL conferred 3.10-fold increased odds of neurosyphilis in HIV-infected subjects. Similar results were obtained when neurosyphilis was more strin-gently defined as a reactive CSF VDRL test result. Conclusion. Serum RPR titer helps predict the likelihood of neurosyphilis. HIV-induced immune impairment may increase the risk of neurosyphilis.

Original languageEnglish (US)
Pages (from-to)369-376
Number of pages8
JournalJournal of Infectious Diseases
Issue number3
StatePublished - Feb 1 2004

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases


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