Evaluation of Treponemal Serum Tests Performed on Cerebrospinal Fluid for Diagnosis of Neurosyphilis

Abstract

Objectives We evaluated the use of treponemal serum tests in cerebrospinal fluid (CSF) to diagnose neurosyphilis since CSF–Venereal Disease Research Laboratory (VDRL) is specific but lacks sensitivity. Methods We tested CSF specimens using the following treponemal serum tests: INNO-LIA, Treponema pallidum particle agglutination (TP-PA), Trep-Sure, and Maxi-Syph. The reference standard to calculate sensitivity and specificity was having two or more reactive/positive tests on CSF. Results The reference standard group included 11 cases that fulfilled the definition of neurosyphilis (reactive CSF-VDRL plus symptoms) and three cases that did not fulfill the definition: two cases had neurologic symptoms but a nonreactive CSF-VDRL, and one had several positive CSF syphilis tests (reactive VDRL and positive treponemal and syphilis polymerase chain reaction) but no history (referred sample). Controls included 18 patients in whom a CSF-VDRL was performed the same week as patients in the reference group. The sensitivity was 85.7% (12/14) for CSF-VDRL, 92.9% (13/14) for Trep-Sure, 100% (10/10) for Maxi-Syph, 92.3% (12/13) for INNO-LIA, and 83.3% (10/12) for TP-PA. Specificity was 100% for all tests. Conclusions Treponemal serum tests performed on CSF were useful in identifying two patients with nonreactive CSF-VDRL.

Diagnostic tools for neurosyphilis: a systematic review

“…The primary finding of our study was a remarkable diversity of tests, which had different purposes (diagnostic confirmation, screening), varied techniques (clinical signs/symptoms, serological analysis, CSF assessment), and a heterogeneous evaluation methodology (including or not HIV-positive individuals, including or not asymptomatic patients, comparing or not with controls, etc.). Most of the articles studied CSF alterations, measuring cells, proteins, treponemal and nontreponemal antibodies [ 16 – 20 ], or applied new immunological/biomolecular techniques [ 21 – 25 ]. Three papers assessed the significance of blood parameters to distinguish between NS+ and NS- [ 26 – 28 ], and only one considered clinical signs or symptoms in the investigation [ 29 ].…”

Choroidal neovascularization secondary to ocular syphilis

“…The Centers for Disease Control and Prevention (CDC) [ 7 ] recommends performing a lumbar puncture and CSF analysis for VDRL and FTA-ABS to detect neurological involvement in people with ocular syphilis. This examination is mandatory in patients with syphilitic optic neuritis and in the case of abnormal CSF results, it is repeated serially every six months to assess treatment response [ 7 , 9 , 10 ]. MRI, in turn, has found application in the detection of gummatous involvement of the CNS [ 11 ].…”

Cerebrospinal Fluid Treponema pallidum Particle Agglutination Assay for Neurosyphilis Diagnosis

“…In contrast to CSF-FTA-ABS, CSF-TPPA does not require specialized equipment and determination of a titer is straightforward. In a few studies, CSF-TPPA has been shown to be highly sensitive (4,5), and the use of a cutoff value for CSF-TPHA, a test similar to CSF-TPPA, increases the specificity for neurosyphilis diagnosis (6,7).…”

“…The sensitivities of CSF treponemal tests are greater than 90% when neurosyphilis is defined as a reactive CSF-VDRL and are lower when the diagnosis of neurosyphilis is based on clinical findings (3). Limited data on the use of the CSF Treponema pallidum particle agglutination assay (CSF-TPPA) for neurosyphilis diagnosis suggest that, like CSF-FTA-ABS, it may be diagnostically sensitive (4,5). The Treponema pallidum hemagglutination assay (TPHA) is similar to TPPA, and two studies have suggested that a CSF-TPHA titer of Ն1:640 is specific for neurosyphilis diagnosis (6,7).…”