title: HIV and syphilis: when to perform a lumbar puncture.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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%).
  
  
  CONCLUSIONS
  In HIV-infected patients with syphilis, lumbar puncture could be restricted to those with neurologic manifestations or a serum RPR > or =1/32.
authors.affiliation: Service des maladies infectieuses, CHU Saint-Pierre, 322 rue haute, 1000 Brussels, Belgium. agnes_libois@stpierre-bru.be
authors.forename: Agnès
authors.initials: A
authors.lastname: Libois
authors.forename: Stéphane
authors.initials: S
authors.lastname: De Wit
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Poll
authors.forename: Felipe
authors.initials: F
authors.lastname: Garcia
authors.forename: Eric
authors.initials: E
authors.lastname: Florence
authors.forename: Ana
authors.initials: A
authors.lastname: Del Rio
authors.forename: Paquita
authors.initials: P
authors.lastname: Sanchez
authors.forename: Eugenia
authors.initials: E
authors.lastname: Negredo
authors.forename: Marc
authors.initials: M
authors.lastname: Vandenbruaene
authors.forename: José M
authors.initials: JM
authors.lastname: Gatell
authors.forename: Nathan
authors.initials: N
authors.lastname: Clumeck
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009494:Neurosyphilis / Q000134:cerebrospinal fluid / Q000150:complications* / Q000175:diagnosis* / Q000382:microbiology; D012372:ROC Curve; D011935:Reagins / Q000097:blood*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013129:Spinal Puncture; D013587:Syphilis / Q000134:cerebrospinal fluid / Q000150:complications / Q000382:microbiology; D014210:Treponema pallidum / Q000276:immunology / Q000302:isolation & purification
chemical_list: D011935:Reagins