Table 2.

Insights on lumbar puncture in the guidelines of neurosyphilis.

Guideline	Continent/Country	Suggestions about lumbar puncture
Guidelines for diagnosis and treatment of syphilis, gonorrhea, and genital Chlamydia trachomatis infection (2020) (110)	China	Lumbar puncture should be performed on all individuals with syphilis and HIV infection to exclude neurosyphilis.
Asian guidelines for syphilis (2022) (99)	Asia	There is no consensus about the need for lumbar puncture in patients with syphilis without any neurological, ocular, or otological symptoms, except for those with tertiary syphilis.
2020 European guideline on the management of syphilis (57)	Europe	CSF assessment is indicated in patients with: -clinical evidence of neurological, ocular, and auricular involvement, whatever the stage of the disease; tertiary syphilis (cardiovascular, gummatous). Some experts still recommend CSF assessment in ANS patients: HIV-positive patients with late syphilis and CD4 cells ≤ 350/mm3 and/or a serum VDRL/RPR titer >1:32; in those who have serological failure or are serofast; in those given alternative treatment for late syphilis.
German guidelines on the diagnosis and treatment of neurosyphilis (102)	German	Lumbar puncture is indicated in patients with (at least two out of four are met): CD4 cell count ≤ 200 cells/μl; untreated HIV infection; detectable HIV load; high VDRL titer (>1:64).
UK national guidelines on the management of syphilis 2015 (111)	UK	Routine CSF examination of patients with latent syphilis is not recommended.

ANS, asymptomatic neurosyphilis; CSF, cerebrospinal fluid; HIV, human immunodeficiency virus; RPR, rapid plasma reagin; VDRL, venereal disease research laborator.