Indications for Lumbar Puncture in Patients With Early Active Syphilis and Human Immunodeficiency Virus Coinfection: Experience in a Tertiary Level Hospital in La Coruña, Spain, 2003-2006

Abstract

Introduction In the last years, the incidence of syphilis has incremented in Spain and coinfection with HIV occurs in a high percentage. In HIV-infected patients with syphilis, neurological complications, treatment failure and relapse appear to be slightly raised. Therefore, careful follow-up must be carried out because of the risk of developing neurosyphilis. According to the guidelines, lumbar puncture (LP) is indicated in HIV-infected patients with late latent syphilis or syphilis of unknown duration, but it is discussed in HIV-infected patients with early active syphilis. Recent research has been developed in order to determine clinical and analytical findings for identification of patients with high neurosyphilis risk. We review different opinions about this topic and report our experience. Methods We have performed LP in all HIV-infected patients with early active syphilis during 2003-2006. Results Of the eight studied patients, none met criteria for neurosyphilis. Three of eight (38%) had a peripheral blood CD4 cell count CD4 + ≤ 350 cells/μL. Seven of eight (87’5%) had RPR ≥ 1:32. Conclusion In these patients, performance of LP could be over indicated because of lack of well-established criterion. Our results are in agreement over to recent studies which restrict indication of LP to specific groups.