{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T15:14:00Z","timestamp":1788362040943,"version":"build-2803163510"},"reference-count":12,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J STD AIDS"],"abstract":"\n Background<\/jats:title>\n Neurosyphilis remains a challenging diagnosis, and the British Association for Sexual Health and HIV (BASHH) guideline recommends lumbar puncture in patients with clinically suspected neurological syphilis. However, the extent to which this guidance is implemented in routine practice across England is uncertain. This study aimed to characterise current approaches to the diagnosis and management of neurosyphilis in England.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted an opportunistic cross-sectional, web-based survey of clinicians managing neurosyphilis in England in March 2025. Eligible services had treated at least one case of neurosyphilis within the preceding 12 months. Data were collected on service characteristics, access to and indications for lumbar puncture, laboratory investigations, treatment regimens, and follow-up practices.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Forty-two responses representing 66 services across England were included. The majority (93%) were level 3 sexual health services, primarily community-based. Neurosyphilis was infrequently encountered (<10 cases\/year in 67% of services). Lumbar puncture practice varied widely: 26% routinely performed lumbar puncture in suspected cases, 21% never performed lumbar puncture, and others reserved lumbar puncture for diagnostic uncertainty or suspected treatment failure. Logistical barriers and perceptions that cerebrospinal fluid (CSF) results would not alter management were common reasons for not performing lumbar puncture. The majority of services (65%) initiated treatment without awaiting CSF results. While 70% used first-line penicillin-based regimens, 23% used ceftriaxone first line, and ceftriaxone was often used in penicillin allergy (18% of services). Follow-up was predominantly serological and clinical; repeat CSF testing was uncommon.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n There is substantial variation in neurosyphilis diagnosis and management across England, with frequent divergence from national guidance. Logistical barriers and diagnostic uncertainty contribute to pragmatic, empiric treatment approaches.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/09564624261483244","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T11:17:39Z","timestamp":1788175059000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The diagnosis and management of neurosyphilis in england, 2025: a cross-sectional survey"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7526-0531","authenticated-orcid":false,"given":"Sarah","family":"Keegan","sequence":"first","affiliation":[{"name":"Guys and St Thomas\u2019 Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9086-9222","authenticated-orcid":false,"given":"Sarah","family":"Alexander","sequence":"additional","affiliation":[{"name":"UK Health Security Agency,"},{"name":"London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6707-6910","authenticated-orcid":false,"given":"Michelle","family":"Cole","sequence":"additional","affiliation":[{"name":"UK Health Security Agency,"},{"name":"London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katy","family":"Sinka","sequence":"additional","affiliation":[{"name":"UK Health Security Agency,"},{"name":"London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7756-403X","authenticated-orcid":false,"given":"Helen","family":"Fifer","sequence":"additional","affiliation":[{"name":"UK Health Security Agency,"},{"name":"London"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"e_1_3_6_2_2","volume-title":"Sexually transmitted infections and screening for chlamydia in England, 2024","author":"Migchelsen SJ","year":"2025","unstructured":"Migchelsen SJ, Daahir U, Macdonald C, et al. Sexually transmitted infections and screening for chlamydia in England, 2024. UK Health Security Agency, 2025. Available from. https:\/\/www.gov.uk\/government\/statistics\/sexually-transmitted-infections-stis-annual-data-tables\/sexually-transmitted-infections-and-screening-for-chlamydia-in-england-2024-report"},{"key":"e_1_3_6_3_2","unstructured":"WHO. Global sexually transmitted infections programme (2026). Available from. https:\/\/www.who.int\/teams\/global-hiv-hepatitis-and-stis-programmes\/stis\/strategic-information"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000001353"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/09564624241280406"},{"key":"e_1_3_6_6_2","author":"The Royal College of Pathologists","year":"2024","unstructured":"The Royal College of Pathologists. Virology 2024. https:\/\/www.rcpath.org\/profession\/publications\/standards-for-microbiology-investigations\/virology.html accessed 20th May 2025.","journal-title":"Virology"},{"key":"e_1_3_6_7_2","unstructured":"Use of doxycycline in pregnancy in neurosyphilis is not specifically addressed in the UK guidelines but caution is generally given around use in pregnancy. Th position statement of BASHH is that it can be considered if treatment is concluded prior to the fifteenth week of gestation where there is not a suitable alternative. See grant A. BASHH position statement on doxycycline use in pregnancy. 2024. Available from. https:\/\/www.bashh.org\/resources\/101\/bashh_position_statement_on_doxycycline_use_in_pregnancy\/"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.rr7004a1"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.16946"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa306"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1086\/313725"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(20)30857-4"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2021-055278"}],"container-title":["International Journal of STD & AIDS"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09564624261483244","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/09564624261483244","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09564624261483244","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T14:25:39Z","timestamp":1788359139000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/09564624261483244"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":12,"alternative-id":["10.1177\/09564624261483244"],"URL":"https:\/\/doi.org\/10.1177\/09564624261483244","relation":{},"ISSN":["0956-4624","1758-1052"],"issn-type":[{"value":"0956-4624","type":"print"},{"value":"1758-1052","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,31]]},"article-number":"09564624261483244"}}