The performance of rapid plasma reagin (RPR) titer in HIV-negative general paresis after neurosyphilis therapy

Ying Jiang,Ruihui Weng,Yulun Liu,Fuhua Peng,Yong Chen,Xiaohong Chen,Zhigang Chen,Yuefeng Zhang,Rong Fan

doi:10.1186/s12879-018-3062-4

Abstract

BackgroundRepeated nontreponemal serologic test for syphilis titers is recommended to evaluate treatment response. However, it is unknown whether serum rapid plasma reagin (RPR) titer can serve as a surrogate for determining the efficacy of treatment in general paresis (GP) remains unknown.MethodsWe retrospectively reviewed data from 105 GP patients, who were divided into two groups (62 CSF RPR+ patients and 43 CSF RPR- patients) according to reactive RPR test status in CSF. Clinical assessment included the Mini-Mental State Examination (MMSE) scores, CSF examinations (WBC count, protein concentration and RPR titer), and serum tests (RPR titer and TPPA). Among the 105 GP patients, 13 CSF RPR+ patients and 6 CSF RPR- patients had a 12 months follow-up of CSF, serum measures and MMSE.ResultsThe median serum RPR titer was significantly higher in CSF RPR+ patients than that in CSF RPR- GP patients, 1:8 [IQR 1:4–1:32] vs. 1:4 [IQR 1:4–1:8] (P < 0.001). The number of CSF RPR+ patients with serum RPR titer≥1:32 was significantly higher when compared with CSF RPR- patients (P = 0.001). For CSF RPR+ patients, the MMSE scores improved or remained constantly after penicillin treatment. For CSF RPR+ patients, the CSF RPR titer declined four-fold in 85% (11/13) of the patients, whereas the serum RPR titer declined four-fold in only 46% (6/13) of the patients, the odds ratio is 6.4 (95% confidence interval 1.0–41.2).ConclusionsA four-fold decline in CSF RPR titer is a good predictor for treatment efficacy in CSF RPR+ GP patients within 12 months after the completion of therapy.

Highlights

Repeated nontreponemal serologic test for syphilis titers is recommended to evaluate treatment response
Thirteen cerebrospinal fluid (CSF) rapid plasma reagin (RPR)+ general paresis (GP) patients returned for follow-up visits with lumbar puncture, Mini-Mental State Examination (MMSE) scores and blood samples in 12 months after penicillin treatment
Fourteen CSF RPR- GP patients returned for follow-up visits with MMSE scores and serological tests in 12 months after penicillin treatment, while 6 of them had a follow-up evaluation of CSF

Summary

Introduction

Repeated nontreponemal serologic test for syphilis titers is recommended to evaluate treatment response. It is unknown whether serum rapid plasma reagin (RPR) titer can serve as a surrogate for determining the efficacy of treatment in general paresis (GP) remains unknown. Haemagglutination test (TPHA) and T. pallidum Particle Agglutination test (TPPA)), symptoms and signs of neurosyphilis and reactive venereal disease research laboratory (VDRL) in cerebrospinal fluid (CSF) or CSF white blood cells (WBCs) > 5/μl or CSF protein > 45 mg/dL are used in the diagnosis of symptomatic neurosyphilis [2]. Repeated titers of nontreponemal (i.e., RPR, VDRL) serologic test for syphilis has been recommended to evaluate treatment response, with a four-fold decrease from baseline and/or seroreversion in 12–24 months after treatment representing an appropriate response to therapy/serologic A reactive rapid plasma reagin (RPR) test in CSF is considered to be the diagnostic of neurosyphilis [2, 3], but this test may be nonreactive in patients with GP depending on the criteria used to define neurosyphilis.

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