<i>Editorial Commentary</i>: Polymerase Chain Reaction for the <i>tpp</i>47 Gene: A New Test for Neurosyphilis

Musher, Daniel M.

doi:10.1093/cid/ciw518

Cited by 7 publications

(8 citation statements)

References 11 publications

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“…In practice, a reactive CSF VDRL is regarded as synonymous with a diagnosis of neurosyphilis. The sensitivity of the CSF VDRL, however, is still debated 3,27 because the lipoidal test that predated the VDRL, the CSF Wasserman, had a very high sensitivity for neurosyphilis: It was reactive in 86% of patients with early syphilitic meningitis (p.44) 5 and in all patients with paretic neurosyphilis (p. 383) 5 , though 28% of patients with tabes dorsalis-particularly those with the later stages or “burned out” tabes-had a negative CSF Wasserman (p. 385). 5 It was even suggested that these numbers were underestimates as most of these cases occurred prior to the recognition of syndromes such as extracranial carotid artery disease, cerebral arteritis, basilar artery insufficiency, lacunar syndromes and viral meningoencephalitis, which may have accounted for some of the CSF abnormalities attributed to syphilis in persons with a nonreactive CSF Wasserman.…”

Section: Diagnosismentioning

confidence: 99%

“…3,30 Not surprisingly, the case selection in the Hooshmand paper has been questioned, with experts suggesting that some of these patients may not have had neurosyphilis. 27,31s It’s worth noting that most papers published in the modern era have suggested a CSF VDRL sensitivity of 50–60%, 32,33s but similar critiques could be leveled against these estimates. At the heart of this controversy is the lack of an alternative gold standard to make the diagnosis of neurosyphilis.…”

Section: Diagnosismentioning

confidence: 99%

“…At the heart of this controversy is the lack of an alternative gold standard to make the diagnosis of neurosyphilis. While some experts have suggested that a clinical diagnosis of neurosyphilis always requires a reactive CSF VDRL, 27 it is unlikely that clinicians will withhold antibiotic therapy from patients with nonreactive CSF VDRLs if there is other compelling evidence for neurosyphilis (e.g. neurological symptoms with CSF pleocytosis and no alternate diagnosis).…”

Section: Diagnosismentioning

confidence: 99%

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Neurosyphilis: Knowledge Gaps and Controversies

Tuddenham

Ghanem²

2018

Sexual Trans Dis

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After reaching a nadir at the turn of the century, syphilis rates in the United States have increased since 2000. Treponema pallidum may disseminate to the central nervous system within hours to days after inoculation. In this review, we focus on knowledge gaps and areas of controversy in neurosyphilis epidemiology, diagnosis, and management. Modern estimates of the prevalence of neurosyphilis are hindered by the lack of consistent reporting data and are based on relatively small retrospective cohort studies. The various diagnostic modalities for neurosyphilis have significant limitations. Although several novel biomarkers for neurosyphilis have been evaluated, none to date have found a place in clinical practice. The role of a cerebrospinal fluid examination in patients without neurological symptoms continues to be an area of controversy, whereas the data for the use of antibiotic regimens other than intravenous aqueous or intramuscular procaine penicillin for the treatment of neurosyphilis are limited. As syphilis incidence continues to increase unabated in many countries around the world, it is critical to address these gaps of knowledge.

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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

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Neurosyphilis: Knowledge Gaps and Controversies

Tuddenham

Ghanem²

2018

Sexual Trans Dis

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“…It is hard to find patients with neurosyphilis who do not present pleocytosis 20 . Although levels of protein in CSF are not sensitive and specific to neurosyphilis diagnosis, protein standardization is essential for post-treatment monitoring [21][22][23][24] .…”

Section: Diagnosismentioning

confidence: 99%

Brazilian Protocol for Sexually Transmitted Infections 2020: acquired syphilis

Freitas

Benzaken

Passos

et al. 2021

Rev. Soc. Bras. Med. Trop.

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The Clinical Protocol and Therapeutic Guidelines for Comprehensive Care of People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020, includes updates concerning acquired syphilis. The document comprises rapid test use, safety and efficacy of benzathine benzylpenicillin, case follow-up, neurosyphilis clinical and laboratory management, approaching sex partners, assistance and monitoring of diagnosed pregnant women, and syphilis and HIV co-infection specificities, as well as a case notification summary. Health managers and professionals must be continuously trained so as to integrate care and surveillance, to strengthen actions for efficient control of syphilis, to broaden the search for sex partners, and to expand access of most vulnerable populations to health services.

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“…It is difficult to find patients with neurosyphilis that do not present pleocytosis in CSF analysis, with the increase in lymphomonocytosis being the most common one 34 . However, CSF protein levels are not sensitive and specific for neurosyphilis, but its standardization is essential for post-treatment monitoring [34][35][36][37] .…”

Section: /8mentioning

confidence: 99%

Brazilian Protocol for Sexually Transmitted Infections 2020: syphilis diagnostic tests

Gaspar

Bigolin

Neto

et al. 2021

Rev. Soc. Bras. Med. Trop.

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The recommendations for diagnostic tests for investigating syphilis are part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections and the Technical Manual for Syphilis Diagnosis, published by the Brazilian Ministry of Health. These recommendations were developed based on scientific evidence and discussions with a panel of experts. This article presents direct tests to detect Treponema pallidum in lesions and algorithms that combine treponemal and nontreponemal antibody tests to assist in syphilis diagnosis, with the aim of contributing to the efforts of health service managers and health professionals in qualifying health care. The article also covers the use of non-treponemal tests to investigate neurosyphilis and guidelines for interpreting non-treponemal antibody titers in monitoring the treatment and diagnosis of congenital syphilis, as well as prospects for innovations in diagnosis. The critical role of rapid immunochromatographic treponemal tests for public health and for addressing syphilis is also highlighted.

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Editorial Commentary: Polymerase Chain Reaction for the tpp47 Gene: A New Test for Neurosyphilis

Cited by 7 publications

References 11 publications

Neurosyphilis: Knowledge Gaps and Controversies

Neurosyphilis: Knowledge Gaps and Controversies

Brazilian Protocol for Sexually Transmitted Infections 2020: acquired syphilis

Brazilian Protocol for Sexually Transmitted Infections 2020: syphilis diagnostic tests

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