Evaluation of treponemal serum tests performed on cerebrospinal fluid for diagnosis of neurosyphilis

Am J Clin Pathol. 2015 Apr;143(4):479-84. doi: 10.1309/AJCPWSL3G8RXMCQR.


Objectives: We evaluated the use of treponemal serum tests in cerebrospinal fluid (CSF) to diagnose neurosyphilis since CSF-Venereal Disease Research Laboratory (VDRL) is specific but lacks sensitivity.

Methods: We tested CSF specimens using the following treponemal serum tests: INNO-LIA, Treponema pallidum particle agglutination (TP-PA), Trep-Sure, and Maxi-Syph. The reference standard to calculate sensitivity and specificity was having two or more reactive/positive tests on CSF.

Results: The reference standard group included 11 cases that fulfilled the definition of neurosyphilis (reactive CSF-VDRL plus symptoms) and three cases that did not fulfill the definition: two cases had neurologic symptoms but a nonreactive CSF-VDRL, and one had several positive CSF syphilis tests (reactive VDRL and positive treponemal and syphilis polymerase chain reaction) but no history (referred sample). Controls included 18 patients in whom a CSF-VDRL was performed the same week as patients in the reference group. The sensitivity was 85.7% (12/14) for CSF-VDRL, 92.9% (13/14) for Trep-Sure, 100% (10/10) for Maxi-Syph, 92.3% (12/13) for INNO-LIA, and 83.3% (10/12) for TP-PA. Specificity was 100% for all tests.

Conclusions: Treponemal serum tests performed on CSF were useful in identifying two patients with nonreactive CSF-VDRL.

Keywords: Cerebrospinal fluid; Neurosyphilis; Treponemal tests; VDRL.

Publication types

  • Evaluation Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antibodies, Bacterial / cerebrospinal fluid*
  • Case-Control Studies
  • DNA, Bacterial / cerebrospinal fluid
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neurosyphilis / cerebrospinal fluid*
  • Neurosyphilis / diagnosis*
  • Neurosyphilis / microbiology
  • Sensitivity and Specificity
  • Syphilis Serodiagnosis / methods*
  • Treponema pallidum / immunology*
  • Treponema pallidum / isolation & purification
  • Young Adult


  • Antibodies, Bacterial
  • DNA, Bacterial