The significance of cerebrospinal fluid routine screening for neurosyphilis

From 1980 to 1985 the cerebrospinal fluid microhaemagglutination assay for Treponema pallidum antibodies (MHA:TP-CSF) was routinely examined from 10 386 consecutive CSF samples of more than 10,000 patients admitted to a large neurological unit in Helsinki. Twenty one patients were considered to have neurosyphilis on the basis of clinical, serological and CSF findings. The MHA:TP-CSF test was positive in 14 patients, in 4 patients the result was undefined, and in 3 patients negative. No false-positive results were obtained. Ten of the patients had no previous history of syphilis demonstrating the value of this type of routine screening, and in only 2 of these patients the diagnosis was suspected by clinicians before the CSF examination. The serum MHA:TP was positive in all examined 18 neurosyphilis patients indicating its value for the routine screening method instead of the CSF examination.