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Lumbar Puncture and Syphilis Outcome

This study is currently recruiting participants.
See Contacts and Locations
Verified May 2017 by Christina Marra, University of Washington
National Institute of Neurological Disorders and Stroke (NINDS)
Information provided by (Responsible Party):
Christina Marra, University of Washington Identifier:
First received: January 6, 2014
Last updated: May 24, 2017
Last verified: May 2017
Treponema pallidum, the bacterium that causes syphilis, invades the central nervous system in about 40% of patients with syphilis. This happens early after infection. Patients with neuroinvasion are at risk of developing serious neurological complications, including vision or hearing loss, stroke and dementia. Because neuroinvasion can happen without symptoms, the only way to identify it is by performing a lumbar puncture (LP) to examine cerebrospinal fluid (CSF).The overall hypothesis to be tested in this study is that a strategy of immediate LP, followed by therapy based on CSF evaluation, results in better serological and functional outcomes in patients with syphilis who are at high risk for neuroinvasion.

Condition Intervention
Syphilis Procedure: Lumbar puncture

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Other
Official Title: Lumbar Puncture and Syphilis Outcome

Resource links provided by NLM:

Further study details as provided by Christina Marra, University of Washington:

Primary Outcome Measures:
  • Serum RPR titer [ Time Frame: 6-12 months ]
    Decline in serum RPR titer by four-fold or to nonreactive at 6 months in early syphilis or at 12 months in late syphilis.

Estimated Enrollment: 280
Study Start Date: August 2013
Estimated Primary Completion Date: June 2019 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Participants undergo lumbar puncture for CSF evaluation
Procedure: Lumbar puncture
No Intervention: No LP
Participants do not undergo lumbar puncture and CSF is not examined.


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Males and females age 18 years or older
  2. Current syphilis
  3. Primary language is English or English is a second language but patient self-describes as fluent in English
  4. Able to provide informed consent
  5. If treated with benzathine penicillin G (BPG), it must have occurred less than 14 days before the entry visit (before the first visit if there is more than one entry visit)

Exclusion Criteria:

  1. Provider plans neurosyphilis (NS) treatment regardless of whether the patient has an lumbar puncture (LP)
  2. Receipt of antibiotic treatment that would be effective for NS (for example, IV or intramuscular (IM) beta-lactam antibiotics [other than BPG]) within one month before study entry; single dose of IM ceftriaxone in the last month is not exclusionary
  3. Allergy to penicillin or lidocaine
  4. Contraindication to LP, including untreatable coagulation disorder, use of anticoagulants that cannot be temporarily discontinued, thrombocytopenia, focal neurological examination
  5. Other known cause of central nervous system (CNS) infection in the last year, including that due to bacterial, fungal, protozoal or viral agents, such as tuberculosis, Cryptococcus, toxoplasmosis or herpes zoster that could confound interpretation of CSF results
  6. Unlikely to be able to comply with study requirements or complete the study, for example, planning to leave the area < 6 months after enrollment
  7. Subjects will not be allowed to re-enroll in this study with a new episode of syphilis

Individuals who are unwilling to be randomized can choose LP or no LP. Eligibility criteria for these individuals are:

  1. 18 years of age or older
  2. Current syphilis infection
  3. Primary language is English or fluent in English
  4. No contraindications to LP
  5. Have not received antibiotics within one month that would treat neurosyphilis
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT02031146

Contact: Christina M Marra, MD 206-897-5400

United States, Washington
University of Washington Harborview Medical Center Recruiting
Seattle, Washington, United States, 98104
Contact: Christina M Marra, MD    206-394-9096   
Sponsors and Collaborators
University of Washington
National Institute of Neurological Disorders and Stroke (NINDS)
Principal Investigator: Christina M Marra, MD University of Washington
  More Information

Responsible Party: Christina Marra, Professor, Neurology, University of Washington Identifier: NCT02031146     History of Changes
Other Study ID Numbers: 45122
R01NS082120 ( U.S. NIH Grant/Contract )
Study First Received: January 6, 2014
Last Updated: May 24, 2017

Additional relevant MeSH terms:
Treponemal Infections
Gram-Negative Bacterial Infections
Bacterial Infections
Sexually Transmitted Diseases, Bacterial
Spirochaetales Infections
Sexually Transmitted Diseases
Genital Diseases, Male
Genital Diseases, Female processed this record on August 17, 2017