Smibert OC, et al. - Researchers reviewed 131 patients (95.4% male; 74% HIV co-infected) with positive serum syphilis serology referred for cerebrospinal fluid (CSF) analysis for the concordance between analysis of CSF and the ensuing antibiotic strategy. Fourteen patients (10.7%) had a confirmed diagnosis of neurosyphilis, however, 44.3% received a neurosyphilis-directed antibiotic regimen, while neurosyphilis therapy was not provided to 35 patients (26.7% of the cohort) who had CSF findings supportive of a diagnosis of neurosyphilis. Observations thereby suggest that therapeutic decisions are made by the clinicians despite the results of CSF analysis. They recommend considering empirical neurosyphilis treatment up front in patients with high pre-test probability of the diagnosis.