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Research Letter
Cerebrospinal fluid TPPA titres in the diagnosis of neurosyphilis
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  1. Fareed Shiva1,
  2. David Goldmeier1,
  3. Paul Lane2,
  4. Helen Ethiopia2,
  5. Alan Winston1,3
  1. 1 Genitourinary Medicine and HIV, Imperial College Healthcare NHS Trust, London, UK
  2. 2 Department of Infection & Immunity, Charing Cross Hospital, London, UK
  3. 3 Department of Medicine, Imperial College London, London, UK
  1. Correspondence to Dr Fareed Shiva, Genitourinary medicine and HIV, Imperial College Healthcare NHS Trust, London W2 1NY, UK; fareed.shiva{at}nhs.net

https://doi.org/10.1136/sextrans-2019-054198

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    Research letter

    Treponema pallidum can be detected in the cerebrospinal fluid (CSF) in up to 30% of early syphilis infection.1 The BASHH guidelines2 recommend a diagnosis of neurosyphilis is based on symptomatology plus CSF white blood cell (WBC) >5 cells/µL, protein >0.45 g/L, a positive CSF Venereal Disease Research Laboratory and a Treponema pallidum particle agglutination (TPPA) titre >1:320. Other major guidelines do not recommend CSF TPPA titre assessment.3 CSF TPPA titres >1:320 are considered to have a high diagnostic yield for neurosyphilis.4 This test is however not widely available. We assessed the clinical utility of implementing CSF TPPA titre results in the diagnosis of neurosyphilis (clinical utility being the relevance and usefulness of an intervention in patient care).

    Data on individuals undergoing CSF examination …

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