HIV and syphilis: when to perform a lumbar puncture

Sex Transm Dis. 2007 Mar;34(3):141-4. doi: 10.1097/01.olq.0000230481.28936.e5.


Objectives: 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.

Study design: 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.

Results: 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%).

Conclusion: In HIV-infected patients with syphilis, lumbar puncture could be restricted to those with neurologic manifestations or a serum RPR > or =1/32.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Female
  • HIV Infections / complications*
  • Humans
  • Male
  • Middle Aged
  • Neurosyphilis / cerebrospinal fluid
  • Neurosyphilis / complications*
  • Neurosyphilis / diagnosis*
  • Neurosyphilis / microbiology
  • ROC Curve
  • Reagins / blood*
  • Risk Factors
  • Sensitivity and Specificity
  • Spinal Puncture*
  • Syphilis / cerebrospinal fluid
  • Syphilis / complications
  • Syphilis / microbiology
  • Treponema pallidum / immunology
  • Treponema pallidum / isolation & purification


  • Reagins