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CSF diagnosis CNS syhpilis Posted: May 18, 2007 QUESTION: Pt with prob late latent syphilis...RPR 1:64. Pt is without s/s neurosyphilis. LP done but with neg VDRL. In an HIV pt with the above, does elevated CSF protein and/or CSF pleocytosis indicate poss CNS syphilis and if so is this enough for you to recommend 14 days IV PEN?


RESPONSE FROM: The CSF VDRL is not very sensitive, therefore neurosyphilis can exist despite a negative test. Given the pleocytosis and high RPR titer, I would treat for neurosyphilis is the treponemal antibody test of blood confirmed infection. DW

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