A study of the prevalence of asymptomatic neurosyphilis in patients with latent syphilis: A 4-year retrospective study from a tertiary care center - reply

Dear Authors,

Thank you very much for reading the article entitled “Frequency of asymptomatic neurosyphilis in cases of latent syphilis (LS): A 4-year retrospective study from a tertiary care center.^[1] I sincerely appreciate the thorough perusal of the article. Opinion has been put forward by the authors that there is no need to do lumbar puncture (LP) in cases of LS quoting guidelines. In the last paragraph of the article, it has been clearly stated by us that since there were only 8 cases (4%) in this study showing asymptomatic neurosyphilis and hence in centers where LP cannot be done, the Centers for Disease Control and Prevention criteria can be followed if there are no signs and symptoms of syphilis.^[1] We have only suggested that in centers, like tertiary care institutes where LP is desirable, where it is done as a routine procedure. Nowhere in the article we have mentioned that LP for LS is mandatory. The other concern raised is that LP can cause severe life-threatening complications. We beg to differ. In the above study, LP was done in 200 patients, none of whom showed any serious documented complications following the procedure other than post-procedural headache, which is often expected.^[1] There are national and international guidelines. Guidelines are formulated for general purposes in any domain of medicine. Should we always tread on the beaten path? In tertiary care teaching institutes, we can afford to deviate. The crux of the matter mentioned in the article is that benzathine penicillin given for LS may not fully work in cases of undiagnosed asymptomatic neurosyphilis due to its poor ability to cross the blood-brain barrier.^[2] The present study is small and we fully agree with the authors that a future comparative study of assessing the clinical endpoints of treatment of LS with and without performing LP is warranted.