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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 …