Spirochetal antibodies in tropical spastic paraparesis: their significance

The prevalence of antibodies to Treponema pallidum and Borrelia burgdorferi was investigated in Jamaicans with tropical spastic paraparesis (TSP). A significantly higher prevalence of reactive serologic tests for syphilis (STS) was found in TSP patients (35.0%) when compared with controls (14.5%; P < .001). Venereal Disease Research Laboratory (VDRL) test titers less than 1:8 were obtained in 88.4% of reactive sera from patients and in all reactive sera of controls. The biologic false-positive rate was also significantly higher in TSP patients (P < .05). A higher frequency of a reactive STS was observed in TSP patients (P < .01) and controls (P < .001) more than 40 years of age. The prevalence of reactive serologic tests for syphilis in TSP patients younger than 40 years was also higher than in controls in this age group (P < .1). The prevalence of positive immunofluorescent antibody tests and enzyme immunoassay for antibodies to B burgdorferi was similar in sera of TSP patients (12.5%) and healthy controls (10%). However, none of the sera was positive by Western immunoblot. Leptospiral antibodies were not present in any serum tested. This study's data do not support an etiologic role for treponemal disease in tropical spastic paraparesis, but rather suggest that the high prevalence of reactive STS in Jamaicans is multifactorial.