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Criteria for undertaking lumbar puncture in the assessment of syphilis.

Sir, One of the most serious complications of untreated syphilis is neurosyphilis. As lumbar puncture is the only objective means of excluding neurosyphilis, it is important that reasonable criteria are set for its being undertaken. This is because, although the procedure is relatively safe, side effects, such as severe post lumbar puncture headache and chronic pain at the site, commonly occur, and patients are often reluctant to submit to the procedure. At the sexually transmitted disease (STD) centre of this hospital we have routinely advised undertaking lumbar puncture for the following groups of patients who have had syphilis diagnosed: (A) those with primary or secondary syphilis, yielding positive reagin test results one year after completion of treatment; (B) those with late latent syphilis, yielding positive serological test results (at a titre of .1/4 to the Venereal Disease Research Laboratory (VDRL) test) that were stable over at least four weeks and who had no clinical evidence of primary or secondary syphilis; (C) those with reinfection or relapse; (D) those with neurological signs; (E) those being followed up after oral treatment with tetracycline, erythromycin or doxycycline; (F) those who had been treated with benzathine penicillin