Do you routinely recommend a lumbar puncture for patients with suspected ocular or otic syphilis in the absence of additional CNS symptoms?

No, this isn’t necessary, assuming no other evidence of non-ocular/otic neurosyphilis. I recommend management as advised by CDC in the 2021 treatment guidelines (https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf, p. 40). An especially careful neurological exam is advised, includin...

No, generally I do not recommend an LP to patients with otic or ocular syphilis, assuming that we are relatively sure about the diagnosis and don't need additional information. An LP in these patients seems superfluous since we already have the diagnosis and, in my experience, most patients don't wa...

No, I don’t think LP adds anything to management.

Besides, unless you are in academia, it is very hard to get LP done.