Screening for neurosyphilis is recommended

EDITOR—Nicoll and Hamers report the prevalence of sexually transmitted diseases, such as syphilis, gonorrhoea, and HIV.1 Despite the frequent invasion of the central nervous system by Treponema pallidum, most infected subjects will not develop neurosyphilis. Several studies have suggested an increased incidence of neurosyphilis, particularly in patients infected with HIV.2

We measured the prevalence of neurosyphilis by screening all serum and cerebrospinal fluid received at the neuropathology laboratory between November 1989 and April 2000 using the venereal disease research laboratory assay and T pallidum haemagglutination assay with fluorescent absorbed treponema antibody. The only exclusion criterion was being positive for HIV.

A total of 9410 samples was screened, of which 195 had positive serology with the fluorescent assay. Of the 195 samples, 67 fulfilled criteria for neurosyphilis.3 Nineteen samples tested negative for fluorescent treponema antibody in cerebrospinal fluid, and neurosyphilis was considered improbable. Twenty one samples had probable neurosyphilis (negative results in research laboratory assay for cerebrospinal fluid) and 27 samples had definite neurosyphilis (positive results in research laboratory …