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Polymerase Chain Reaction for the tpp47 Gene: A New Test for Neurosyphilis

  1. Daniel M. Musher
  1. Baylor College of Medicine and Medical Care Line, Infectious Disease Section, Michael E. DeBakey Medical Center, Houston, Texas
  1. Correspondence: D. M. Musher, Veterans Affairs Medical Center, 2002 Holcombe Blvd, Houston TX 77030 (daniel.musher{at}

Key words

The Holy Grail of neurosyphilis is a specific and sensitive diagnostic test that can be done on cerebrospinal fluid (CSF) to diagnosis this disease. The goal of the study by Vanhaecke et al, reported in this issue of Clinical Infectious Diseases, was to study the utility of polymerase chain reaction (PCR) for the tpp47 gene of Treponema pallidum in 40 patients with “well-documented neurosyphilis” [1]. But, as the authors themselves state, “Neurosyphilis has multiple clinical presentations, and there is no consensus concerning its definition.” For reasons that I will explore below, confusion over the diagnosis of neurosyphilis leaves this reader uncertain as to which patients in Vanhaecke et al's series of 40 cases actually had neurosyphilis. In this context, the addition of PCR does not look to be very helpful.

During the incubation period leading up to the appearance of a chancre, and while the chancre is present, T. pallidum disseminates widely throughout the body. Organisms may be found in the CSF of up to 40% of patients with primary and secondary syphilis [24]. These patients have no symptoms, and this is …


This Article

  1. Clin Infect Dis. doi: 10.1093/cid/ciw518
  1. All Versions of this Article:
    1. ciw518v1
    2. ciw518v2 most recent


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