Oligosymptomatic neurosyphilis with false negative CSF-VDRL in HIV-infected individuals?

Abstract

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.

• Authors: R Malessa, M W Agelink, U Hengge, L Mertins, M Gastpar, N H Brockmeyer
• Journal: European journal of medical research (Eur J Med Res) Vol. 1 Issue 6 Pg. 299-302 (Mar 19 1996) ISSN: 0949-2321 [Print] England
• PMID: 9367943 (Publication Type: Journal Article)

Chemical References

• Anti-Bacterial Agents
• Cardiolipins
• Penicillins
• Phosphatidylcholines
• VDRL antigen
• Erythromycin
• Cholesterol
• Penicillin G

Topics

• Adult
• Anti-Bacterial Agents (therapeutic use)
• Cardiolipins (cerebrospinal fluid)
• Cholesterol (cerebrospinal fluid)
• Erythromycin (therapeutic use)
• False Negative Reactions
• HIV Infections (complications)
• HIV Seropositivity (complications)
• Humans
• Male
• Middle Aged
• Neurosyphilis (complications, diagnosis, drug therapy, epidemiology)
• Penicillin G (therapeutic use)
• Penicillins (therapeutic use)
• Phosphatidylcholines (cerebrospinal fluid)
• Prevalence
• Reproducibility of Results
• Sensitivity and Specificity