Editorial Response: Diagnosing Neurosyphilis

Abstract

Neurosyphilis is difficult to diagnose. No diagnostic test or combination of tests is sufficiently sensitive and specific to serve as a gold standard to provide comparative data for detailed evaluation of newly developed diagnostic tests or algorithms. Over the past decade, problems associated with the diagnosis of neurosyphilis have increased as syphilis has become more common and as human immunodeficiency virus (HIV) infection-which may cause CSF abnormalities similar to those associated with CNS invasion by Treponema pallidum [1-3]-has been closely associated with syphilis. For many clinicians, however, the problems related to diagnosis of neurosyphilis may be clarified if they remind themselves of the rationale for pursuing the diagnosis and of the goals of therapy for the disease.