{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T10:36:19Z","timestamp":1784543779405,"version":"3.55.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>The study aimed to assess the association between CSF-TPPA titer and the presence of neurosyphilis, and to determine the optimal CSF-TPPA titer cutoff for diagnosing neurosyphilis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a cross-sectional study at a single center from April 2020 and January 2022.Receiver operating characteristic (ROC) analysis was used to assess the performance of CSF-TPPA titer in the diagnosis for neurosyphilis. The relationship between CSF-TPPA titer and neurosyphilis was investigated by restricted cubic spline (RCS) curves.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 715 HIV-negative syphilis patients were included in the final analysis. CSF-TPPA was reactive in 443 cases (62.0%), with a median titer of 1:160 (IQR, Negative to 1:2560). The area under curve (AUC) of CSF-TPPA titer was 0.967 (95% Confidence interval (CI): 0.951- 0.979). CSF-TPPA titer \u2265 1:320 provided a sensitivity of 92.53% and a specificity of 87.96% for the identification of neurosyphilis. For those presumptive neurosyphilis patients, CSF-TPPA \u22651:320 could effectively identified symptomatic neurosyphilis. The RCS curve revealed a non-linear and positive association between CSF-TPPA titer and risk of neurosyphilis. After full adjustments for confounding covariates, it showed that the prevalence of neurosyphilis was relatively flat until CSF-TPPA titer reached 1:320 and then started to escalated rapidly afterwards.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study revealed that a CSF-TPPA titer \u2265 1:320 can be used as a highly sensitive and practical marker for diagnosing neurosyphilis. A titer threshold of \u22651:320 could offer a reliable alternative in cases when CSF-VDRL is negative.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2025.1572137","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T08:09:23Z","timestamp":1743149363000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Evaluation of cerebrospinal fluid treponema pallidum particle agglutination assay titer for neurosyphilis diagnosis among HIV-negative syphilis 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