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LP in Syphilis with HIV — SCE Infectious Diseases MCQ

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HardSTIsLP in Syphilis with HIVSCE Infectious Diseases

A person with primary syphilis and well-controlled HIV has no neurological, ocular or otic symptoms and responds appropriately to treatment. What is the correct CSF-testing principle?

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Correct answer: E — Do not perform routine lumbar puncture primarily because of HIV; investigate CSF when neurological, ocular, otic or treatment-failure features justify it with review

The best answer is “Do not perform routine lumbar puncture primarily because of HIV; investigate CSF when neurological, ocular, otic or treatment-failure features justify it with review”. Current guidance bases CSF assessment on compatible manifestations or inadequate response rather than HIV status alone. “Perform CT brain before every syphilis treatment” is less appropriate because it conflicts with the clinical discriminator or cited guidance. “Perform lumbar puncture in all primary syphilis” is less appropriate because it conflicts with the clinical discriminator or cited guidance. “Never perform lumbar puncture in syphilis under any circumstance” is less appropriate because it conflicts with the clinical discriminator or cited guidance. “Use serum RPR alone even when neurological symptoms develop” is less appropriate because it conflicts with the clinical discriminator or cited guidance.

Reference: BASHH syphilis guideline 2024: https://www.bashh.org/resources/25/guidelines_syphilis_2024/