Assignment task:
A 29-year-old transgender woman presents with a new severe headache and diffuse rash on her chest and back. Laboratory studies showed she had a positive treponemal enzyme immunoassay (EIA) and a positive serum Rapid Plasma Reagin (RPR) with a titer of 1:128. Initial lumbar puncture cerebrospinal fluid (CSF) studies showed a white blood cell count of 36 cells/mm3 (84% lymphocytes), protein of 78 mg/dL, and positive Venereal Disease Research Laboratory (VDRL) titer of 1:64. An HIV-1/2 antigen-antibody test was negative. She is diagnosed with secondary syphilis and neurosyphilis and receives appropriate treatment. Six months later her neurologic symptoms have resolved, and a repeat serum RPR titer is 1:8. Which one of the following should be recommended regarding a follow-up lumbar puncture with CSF analysis? Lumbar puncture with CSF analysis is not required if the individual achieves an appropriate clinical and serologic response Lumbar puncture with CSF analysis should be repeated every 3 months until the cell count is normal A lumbar puncture with CSF analysis should be repeated every 6 months until the cell count is normal A lumbar puncture with CSF analysis should be repeated every 12 months until the cell count is normal