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An Analysis of the Benefits and Risks

Joseph Wiesel, MD; David N. Rose, MD; Alan L. Silver, MD, MPH; Henry S. Sacks, PhD, MD; Richard H. Bernstein, MD

Arch Intern Med. 1985;145(3):465-468.

Abstract
• We evaluated the treatment of asymptomatic patients with untreated syphilis of more than one year's duration (asymptomatic late syphilis) using a decision-analysis model. Two strategies were compared: treatment with 7.2 million units of penicillin G benzathine, or performing a lumbar puncture to test for asymptomatic neurosyphilis followed by penicillin and management based on cerebrospinal fluid analysis. Estimates of probabilities of disease prevalence, test sensitivity, and cure and complication rates were derived from published studies. Both strategies resulted in a cure rate of at least 99.7% using the best estimates. Although the strategy using lumbar puncture results in a 0.2% higher cure rate, its rate of complications (0.3%) exceeds its marginal benefit. We conclude that a lumbar puncture offers little additional benefit and may increase morbidity in patients with asymptomatic late syphilis.

(Arch Intern Med 1985;145:465-468)

Author Affiliations
From the Departments of Medicine (Drs Wiesel, Rose, Silver, Sacks, and Bernstein), Community Medicine (Drs Rose, Silver, and Bernstein), and Biomathematical Sciences (Dr Sacks), Mount Sinai School of Medicine of the City University of New York. Dr Wiesel is now with the Department of Medicine, Long Island-Jewish Hillside Medical Center, New Hyde Park, NY.

Footnotes
Accepted for publication July 27, 1984.

Reprint requests to Department of Community Medicine, Mount Sinai School of Medicine, 1 Gustave L. Levy PI, New York, NY 10029 (Dr Rose).

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