Repeating cerebrospinal fluid treponemal tests: Four cases and literature review

Current recommendations from the Centers for Disease Control and Prevention (United States) require the diagnosis of neurosyphilis to be made based on a combination of clinical presentation, reactive serologic tests, and cerebrospinal fluid abnormalities. The test of choice for neurosyphilis, which is the cerebrospinal fluid Venereal Disease Research Laboratory, is limited by its low sensitivity. We describe 4 patients with a clinical presentation of neurosyphilis, with an initial negative cerebrospinal fluid Venereal Disease Research Laboratory test that turned positive on repeated testing. In cases of suspected neurosyphilis, repeated testing of the cerebrospinal fluid for Venereal Disease Research Laboratory may increase the diagnostic yield for neurosyphilis.