title: Central nervous system involvement in early and late syphilis: the problem of asymptomatic neurosyphilis.
abstract: Patients with syphilitic infections are at risk of development of symptomatic neurosyphilis. Adequate treatment with 2.4-7.2 x 10(6) units benzyl penicillin-G intramuscularly within 1 year after infection will rule out this risk. However, more than 1 year after infection this treatment is not fully reliable. In asymptomatic CNS involvement (asymptomatic neurosyphilis) only intravenous penicillin treatment is considered to be adequate in the prevention of neurosyphilis. In this study we redefined criteria for this condition by comparing serum and cerebrospinal fluid (CSF) samples of symptomatic neurosyphilitic patients with those of latent syphilitic patients without CNS involvement. Diagnostic criteria of the World Health Organization and of Centers of Disease Control for asymptomatic neurosyphilis (positive CSF Venereal Disease Research Laboratory (VDRL) test, combined with raised CSF cell count and/or protein content) were studied and compared with some newer parameters such as signs of intrathecal treponemal antibody production (Treponema pallidum haemagglutination assay and intrathecal Treponema pallidum assay index), immunoglobulin G (IgG) and M (IgM) index. The results of this study in 203 syphilitic patients revealed that either a positive CSF-VDRL or combination of a raised IgG and/or IgM index with an elevated CSF cell count both are useful criteria for "ruling-in" asymptomatic neurosyphilis.
authors.affiliation: Department of Neurology, Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands.
authors.forename: E C
authors.initials: EC
authors.lastname: Wolters
authors.forename: E A
authors.initials: EA
authors.lastname: Hische
authors.forename: J A
authors.initials: JA
authors.lastname: Tutuarima
authors.forename: L
authors.initials: L
authors.lastname: van Trotsenburg
authors.forename: R V
authors.initials: RV
authors.lastname: van Eijk
authors.forename: J D
authors.initials: JD
authors.lastname: Bos
authors.forename: T M
authors.initials: TM
authors.lastname: Starink
authors.forename: L J
authors.initials: LJ
authors.lastname: Emsbroek
authors.forename: H J
authors.initials: HJ
authors.lastname: van der Helm
mesh_terms: D006801:Humans; D009494:Neurosyphilis / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy*; D010400:Penicillin G / Q000627:therapeutic use*; D013587:Syphilis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D010400:Penicillin G