An HIV-positive patient with syphilis is at increased risk of developing neurosyphilis, which may be asymptomatic. Ghanem et al listed criteria for when to perform a lumbar puncture (LP) in order to diagnose neurosyphilis in these patients.
Patient selection: simultaneous infection with syphilis and HIV
Indications to perform a lumbar puncture (and look for neurosyphilis) - one or more of the following:
(1) neurological signs and symptoms consistent with neurosyphilis
(2) CD4 count <= 350 cells per mL
(3) RPR titer >= 1:32
(4) syphilis stage either late latent or of unknown duration
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