Serological Response Predicts Normalization of Cerebrospinal Fluid Abnormalities at Six Months after Treatment in HIV-Negative Neurosyphilis Patients

Yao Xiao,Kun Gao,Tian-Ci Yang,Hui-Lin Zhang,Wei-Hong Zheng,Hui-Ling Lin,Zhi-Feng Lin,Li-Rong Lin,Shu-Lian Li,Man-Li Tong,Li-Li Liu,Jian-Jun Niu,Mei-Jun Chen

doi:10.1038/s41598-017-10387-x

Abstract

This study aimed to determine whether a serological response could predict the normalization of cerebrospinal fluid (CSF) abnormalities at 6 months after treatment in human immunodeficiency virus (HIV)-negative neurosyphilis patients. A total of 123 neurosyphilis patients were recruited at baseline, 58 of these patients undergoing treatment, repeated CSF examinations and serological tests for syphilis at 6 months after treatment were included in the follow-up study. Before treatment, the CSF rapid plasma reagin (RPR) titer, CSF Treponema pallidum particle agglutination (TPPA) titer, CSF leukocyte count, and CSF protein concentration were correlated with both serum RPR and TPPA titers. At 6 months after treatment, 28 and nine patients achieved serological responses of RPR and TPPA tests, respectively. The sensitivities of the serological response of RPR and TPPA tests for identifying the normalization of CSF abnormalities were 60.0∼83.3% and 17.1~22.2%, respectively; and 75.0∼91.3% of patients showing serological response of RPR test also achieved CSF normalization, suggesting that the serological response could predict CSF normalization to some degree. Particularly, in patients with ≥8-fold decreases in the serum RPR titer, the CSF RPR, CSF leukocyte count, and CSF protein concentration had normalized, and follow-up lumbar puncture could be reduced considering the resolution of neurological symptoms.

Highlights

In addition to the diagnosis of neurosyphilis, the efficacy of neurosyphilis treatment is mainly assessed by cerebrospinal fluid (CSF) examination
We assessed whether the serological response of the rapid plasma reagin (RPR) and Treponema pallidum particle agglutination (TPPA) tests could help predict the normalization of CSF abnormalities after treatment in human immunodeficiency virus (HIV)-negative neurosyphilis patients
In HIV-infected patients, Marra et al.4 observed that the odds of normalization of the CSF VDRL titer, CSF leukocyte count and CSF protein concentration after treatment were 57, 41- and 28-fold higher, respectively, when the serum RPR titer had normalized than when it had not

Summary

Introduction

In addition to the diagnosis of neurosyphilis, the efficacy of neurosyphilis treatment is mainly assessed by CSF examination. There is an urgent need to find a surrogate for the normalization of CSF abnormalities after neurosyphilis treatment. Decrease in the serum RPR titer or reversion of the test to a nonreactive status could be a strong indicator of a successful neurosyphilis treatment. In that study, >90% of patients demonstrating normalization of the serum RPR titer showed normalization of clinical and CSF abnormalities, with the exception of the CSF protein concentration, at 13 months after treatment. Whether the HIV status influences the relationship between the serum RPR titer and treatment success remains unclear. We assessed whether the serological response of the RPR and TPPA tests could help predict the normalization of CSF abnormalities after treatment in HIV-negative neurosyphilis patients

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