Predictive value of neurological symptoms in persons with suspected neurosyphilis

Treponema pallidum is detected in the cerebrospinal fluid (CSF) in up to 30% of individuals with early syphilis.1 An ongoing challenge in accurate diagnoses of neurosyphilis (NS) is variable symptomatology at presentation. Often, individuals with reactive syphilis serology and neurological symptoms are empirically treated for neurosyphilis. We previously described the utility of CSF Treponema Pallidum Particle Agglutination (TPPA) titres in the diagnosis of NS.2 Here, we assess the utility of presenting neurological symptoms in the diagnosis of NS. Data on individuals whom a diagnosis of NS was being considered and a CSF examination undertaken, between January 2017 and November 2020, were gathered and included presenting symptoms and serum rapid plasma reagin (RPR) …