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Public Health Rep. 1977 May-Jun; 92(3): 260–262.
PMCID: PMC1432001

Cerebrospinal fluid serology--is its routine use justifiable?


Although neurospyhilis has become a rare disease, requests for cerebrospinal fluid (CSF) syphilis serology tests at the Colorado Department of Health have increased in recent years. Because of the low rate of positive results, questionnaires were sent to the physicians who requested these tests to determine the criteria for their use. Neurosyphilis was neither suspected nor an important consideration to rule out in 63 percent of the 337 patients sampled. Of the patients whose ages were specified, more than half were under age 40. No concomitant reports of blood serology were available for 63 percent of the study patients, and only 13 percent of the available blood serology reports indicated reactivity. One of the two patients with positive test results was appropriately treated, but the other patient for whom the test was ordered 'routinely' to rule out neurosyphilis was lost to followup. One-half of the tests were requested by neurologists, neurosurgeons, and orthopedists. The survey findings indicated that most of the CSF serologic tests for syphilis were done without appropriate preliminary testing for patients who had no evidence of syphilis by physicians who perform lumbar punctures as a consequence of their specialties. The authors recommend that use of the test be reviewed in light of the changing epidemiology of the disease. They further suggest that directors of laboratories performing CSF serologic tests are in a unique position to initiate an educational exchange and a consequent change in physicians' behavior.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • KOFMAN O. The changing pattern of neurosyphilis. Can Med Assoc J. 1956 May 15;74(10):807–812. [PMC free article] [PubMed]
  • Hooshmand H, Escobar MR, Kopf SW. Neurosyphilis. A study of 241 patients. JAMA. 1972 Feb;219(6):726–729. [PubMed]
  • Dans PE. Treatment of Gonorrhea and syphilis: Part II--syphilis. South Med J. 1975 Oct;68(10):1295–1303. [PubMed]
  • Izzat NN, Bartruff JK, Glicksman JM, Holder WR, Knox JM. Validity of the VDRL test on cerebrospinal fluid contaminated by blood. Br J Vener Dis. 1971 Jun;47(3):162–164. [PMC free article] [PubMed]
  • Duncan WP, Jenkins TW, Parham CE. Fluorescent treponemal antibody-cerebrospinal fluid (FTA-CSF) test. A provisional technique. Br J Vener Dis. 1972 Apr;48(2):97–101. [PMC free article] [PubMed]
  • Jaffe HW. The laboratory diagnosis of syphilis. New concepts. Ann Intern Med. 1975 Dec;83(6):846–850. [PubMed]
  • Griner PF, Liptzin B. Use of the laboratory in a teaching hospital. Implications for patient care, education, and hospital costs. Ann Intern Med. 1971 Aug;75(2):157–163. [PubMed]
  • Martin SP. The clinical laboratory: cost benefit and effectiveness. Ann Intern Med. 1971 Aug;75(2):309–310. [PubMed]

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