Christina M. Marra, MD
Professor, Department of Neurology
Adjunct Professor, Department of Medicine, Division of Allergy
& Infectious Disease
The focus of our research is on syphilis and neurosyphilis. We began a
study of cerebrospinal fluid abnormalities in patients with syphilis in1996. Broadly stated, the goal of
the project was to identify which patients with syphilis are at increased risk for neurosyphilis, to
identify means to better diagnose neurosyphilis in HIV-infected patients, and to determine the best ways
to assess the success of neurosyphilis treatment. We were able to show that easily identifiable clinical
factors, including high serum rapid plasma reagin (RPR) titer and whether an HIV-infected patient was
taking antiretrovirals, influence neurosyphilis risk. We also showed that the infecting Treponema
pallidum strain type and polymorphisms in host toll like receptor genes increase neurosyphilis
We are currently conducting a trial aimed at determining whether lumbar puncture early in syphilis with
treatment decisions based on cerebrospinal fluid findings improves serological, cognitive and functional
outcome in HIV-infected and -uninfected patients with syphilis. In the laboratory, we are exploring
genetic risks for neurosyphilis using whole exome sequencing. We are also examining differences in host
macrophage and T. pallidum-specific opsonic antibody function in patients with uncomplicated
syphilis and neurosyphilis.
1. Marra CM, Tantalo LC, Sahi SK, Maxwell CL, Lukehart SA. CXCL13 as a cerebrospinal fluid marker for neurosyphilis
in HIV-infected patients with syphilis. Sex Transm Dis 2010;37:283-7.
2. Marra CM, Sahi SK, Tantalo LC, Godornes C, Reid T, Behets F, et al. Enhanced molecular typing of Treponema
pallidum: geographical distribution of strain types and association with neurosyphilis. J Infect Dis 2010;202:
3. Marra CM, Tantalo LC, Maxwell CL, Ho EL, Sahi SK, Jones T. The rapid plasma reagin test cannot replace the venereal
disease research laboratory test for neurosyphilis diagnosis. Sex Transm Dis 2012;39:453-7.
4. Grimes M, Sahi SK, Godornes BC, Tantalo LC, Roberts N, Bostick D, Marra CM, Lukehart SA. Two Mutations Associated
With Macrolide Resistance in Treponema pallidum: Increasing Prevalence and Correlation With Molecular Strain Type
in Seattle, Washington. Sex Transm Dis 2012;39:954-8.
5. Marra CM, Deutsch R, Collier AC, Morgello S, Letendre S, Clifford D, Gelman B, McArthur J, McCutchan JA, Simpson
DM, Duarte DA, Heaton RK, Grant I, for the CHARTER Study Group. Neurocognitive Impairment in HIV-infected
Individuals with Previous Syphilis. Int J STD & AIDS. 2013;24:351-5.
6. Marra CM, Sahi SK, Tantalo LC, Ho EL, Dunaway SB, Jones T, Hawn TR. Toll-like receptor polymorphisms are
associated with increased neurosyphilis risk. Sex Transm Dis 2014;41:440-446.
7. Scheld WM, Whitley RJ, Marra CM (Eds). Infections of the Central Nervous System, Fourth Edition. Philadelphia.
Lippincott, Williams and Wilkins. 2014.