Oligosymptomatic neurosyphilis with false negative CSF-VDRL in HIV-infected individuals?
The true prevalence of neurosyphilis in HIV-infection is unknown, since a sufficiently sensitive and specific test is lacking. In a prospective study we found reactive serum TPHA and FTA-ABS IgG tests in 95 (31%) of 307 HIV-infected patients. Three of 11 patients with latent syphilis revealed reactive CSF-VDRL tests, six others only demonstrated CSF abnormalities. Resolution of CSF abnormalities during a six month follow up after high dose antibiotic therapy led to the diagnosis of oligosymptomatic or asymptomatic neurosyphilis in all nine patients. Thus, the specificity of the CSF-VDRL was 100%, but the sensitivity was only 33%. The overall prevalence of neurosyphilis was 2.9%, increasing to 9.5% in patients with a reactive serum TPHA. Our study emphasizes the importance of antibiotic therapy for presumptive neurosyphilis in HIV-infected patients with latent syphilis and CSF abnormalities but nonreactive CSF-VDRL tests, even if they are neurologically asymptomatic or present with complaints inconclusive of neurosyphilis.
Malessa
R
R
Department of Neurology, University of Essen, Hufelandstr. 55, Essen D-45147, Germany.
Agelink
M W
MW
Hengge
U
U
Mertins
L
L
Gastpar
M
M
Brockmeyer
N H
NH
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002308:Cardiolipins / Q000134:cerebrospinal fluid*; D002784:Cholesterol / Q000134:cerebrospinal fluid*; D004917:Erythromycin / Q000627:therapeutic use; D005188:False Negative Reactions; D015658:HIV Infections / Q000150:complications*; D006679:HIV Seropositivity / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009494:Neurosyphilis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D010400:Penicillin G / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use; D010713:Phosphatidylcholines / Q000134:cerebrospinal fluid*; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D000900:Anti-Bacterial Agents; D002308:Cardiolipins; D010406:Penicillins; D010713:Phosphatidylcholines; C054448:VDRL antigen; D004917:Erythromycin; D002784:Cholesterol; D010400:Penicillin G