Frontiers in neurology · 2026
Post-treatment serologic, cerebrospinal fluid, MRI, and salivary antibody responses in HIV-negative neurosyphilis: a retrospective study.
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Long Xuan, Lin Weipeng, Shen Jiahui, Zhong Xueying, Wu Sichan, Liu Donghua
Аннотация
OBJECTIVES: This study aimed to characterize longitudinal serologic, cerebrospinal fluid (CSF), MRI, and salivary antibody responses after treatment in HIV-negative neurosyphilis.
METHODS: We retrospectively analyzed 73 HIV-negative adults treated for neurosyphilis from June 2021 to June 2025. Survival endpoints were defined as time to first documented serologic response or CSF normalization. Paired baseline and 12-month saliva samples were available for 25 patients. Cox models were exploratory, and longitudinal MRI findings were analyzed descriptively.
RESULTS: Among 25 patients with paired saliva samples, salivary antibody OD decreased at 12 months (estimated paired decrease, 0.36 OD units; 95% CI, 0.14-0.64) and showed a modest correlation with the decline in serum TRUST titer (Spearman ρ = 0.396). Of 73 patients, 36 achieved a first documented serologic response. Higher baseline serum TRUST titer was associated with earlier documented response (adjusted HR per twofold increase, 1.34; 95% CI, 1.11-1.61), whereas elevated CSF protein was associated with later documented response (adjusted HR, 0.41; 95% CI, 0.20-0.86). Median times to first documented normalization were 12 months for CSF TRUST, 13 months for CSF WBC, and 20 months for CSF protein; these estimates were derived from separate endpoint-specific risk sets. Follow-up MRI findings in 13 clinically selected patients were descriptive.
CONCLUSION: The post-treatment decline in salivary anti-T. pallidum antibody OD provides a preliminary non-invasive signal of treatment-associated change. Prospective validation in larger cohorts is required.
METHODS: We retrospectively analyzed 73 HIV-negative adults treated for neurosyphilis from June 2021 to June 2025. Survival endpoints were defined as time to first documented serologic response or CSF normalization. Paired baseline and 12-month saliva samples were available for 25 patients. Cox models were exploratory, and longitudinal MRI findings were analyzed descriptively.
RESULTS: Among 25 patients with paired saliva samples, salivary antibody OD decreased at 12 months (estimated paired decrease, 0.36 OD units; 95% CI, 0.14-0.64) and showed a modest correlation with the decline in serum TRUST titer (Spearman ρ = 0.396). Of 73 patients, 36 achieved a first documented serologic response. Higher baseline serum TRUST titer was associated with earlier documented response (adjusted HR per twofold increase, 1.34; 95% CI, 1.11-1.61), whereas elevated CSF protein was associated with later documented response (adjusted HR, 0.41; 95% CI, 0.20-0.86). Median times to first documented normalization were 12 months for CSF TRUST, 13 months for CSF WBC, and 20 months for CSF protein; these estimates were derived from separate endpoint-specific risk sets. Follow-up MRI findings in 13 clinically selected patients were descriptive.
CONCLUSION: The post-treatment decline in salivary anti-T. pallidum antibody OD provides a preliminary non-invasive signal of treatment-associated change. Prospective validation in larger cohorts is required.