Syphilis treatment and outcomes in HIV-positive patients: Does a lumbar puncture make a difference?

• Objective: To determine if lumbar puncture (LP) improves clinical outcomes for HIV+ patients with syphilis who meet Centers for Disease Control and Prevention (CDC) criteria for LP. • Methods: A retrospective review of HIV+ patients with syphilis was conducted. The primary endpoint was treatment failure, defined as serological failure, clinical neurosyphilis, or syphilis retreatment. We compared success versus failure based on whether an LP was done as well as syphilis and HIV demographic characteristics. • Results: 28 cases were included. LP was performed on 10 cases (35.7%). Treatment success was 80% and 82.4% for the LP and no LP groups, respectively. Five patients failed therapy. No patient characteristic predicted failure. All failures were serologic failures. No patient had clinical failure during a mean follow up of 38.2 months. • Conclusion: Our data suggest that LP in HIV patients without clinical symptoms of neurosyphilis did not affect treatment success. Future studies on HIV and syphilis should focus on clinical outcomes.