Predictors for Neurosyphilis in HIV-Infected Patient with Early Syphilis

 

Patient selection: HIV-positive with early syphilis

 

Predictors for neurosyphilis:

(1) headache

(2) visual symptoms (diplopia, blurred vision, flashes, decreased vision)

(3) CD4 lymphocyte count < 500 per µL

(4) HIV-1 RNA >= 50 copies per mL (viremia)

 

FTA-ABS and INNO-LIA both showed 100% sensitivity but poor specificity. Both had a 100% negative predictive value.

 

The highest specificity was shown by CSF PCR in a patient with clinical symptoms at 81%.

 

The authors noted a correlation between the degree of pleocytosis in the CSF and detection of T. pallidum DNA by PCR. A CSF white cell count > 20 cells per microliter was used as the cutoff. A negative PCR in a patient with negative CSF VDRL and CSF WBC count > 20 cells per µL had a 98% negative predictive value.