Algorithm for diagnosis of neurosyphilis in a patient without HIV infection

CIA: chemiluminescence immunoassay; CSF: cerebrospinal fluid; TP-EIA: Treponema pallidum enzyme immunoassay; FTA-ABS: fluorescent treponemal antibody-absorbed test; NS: neurosyphilis; TPPA: Treponema pallidum particle agglutination test; LP: lumbar puncture; VDRL: Venereal Disease Research Laboratory test; WBC: white blood cell.
* A reactive serum TP-EIA or CIA should be confirmed with a different treponemal test.
¶ Otologic or ocular syphilis may not be accompanied by CSF abnormalities. Patients with otologic symptoms should be evaluated by an otolaryngologist and patients with ocular symptoms should be evaluated by an ophthalmologist, and if findings are consistent with otologic or ocular syphilis, these patients should be treated for neurosyphilis even if the CSF is normal. With the exception of tabes dorsals, other forms of neurosyphilis are very uncommon in the absence of CSF abnormalities.
Δ Monitor with neurologic examination and LP to determine success of therapy and potential need for retreatment (refer to UpToDate topic on neurosyphilis for details).