Community and Hospital HIV Follow-Up Clinics Achieve Similar Lumbar Puncture and Syphilis Treatment Success in...

The rates of HIV and syphilis in Saskatchewan (SK) have been rising rapidly in recent years. The syndemic has raised concern for neurosyphilis, a complication that can occur at any stage of syphilis and is more common in people living with HIV (PLWH). Criteria published by the Public Health Agency of Canada recommends considering a lumbar puncture (LP) in patients with concomitant HIV and syphilis infection whose rapid plasma reagin (RPR) titre is ≥1:32 or whose CD4+ count is ≤350. We assessed whether this recommendation was met at 2 comparable clinical sites.

In this retrospective analysis, we compare rates of LP and corresponding syphilis treatment success at two clinics in Saskatoon, SK: a community-based primary care clinic and a tertiary care hospital-based infectious disease clinic.

Of 193 syphilis cases across both sites, 128 cases met laboratory criteria for lumbar puncture. Rates of LP (9% primary care clinic and 19% infectious disease clinic) and syphilis treatment success (87% primary care clinic and 89% infectious disease clinic) were comparable between groups. When RPR titre was controlled for, clinic type did not statistically significantly affect the rates of lumbar puncture (p = 0.104) or syphilis treatment success (p = 0.068). A RPR titre ≥1:32 was positively associated with both treatment success (OR 2.596) and lumbar puncture (OR 4.495).

Results suggest that there is no difference in either the community or hospital-based clinic type for syphilis treatment success and that rates of lumbar puncture of patients meeting serologic criteria are low across diverse HIV patient groups and clinical settings.