Nontreponemal screening tests have a sensitivity of 70-90% in primary syphilis. It needs to be confirmed by a treponemal test. All serological tests are positive at secondary stage and sensitivity for all tests including VDRL test which is approximately 100%; however, in 1-2% of patients' false-negative nontreponemal tests can occur due to prozone phenomenon. A presumptive diagnosis is based on the presence of typical rash and reactive non-treponemal tests in a titer ≥1:8 in a patient with no previous history of syphilis. Std test near Paauhau. If history of syphilis is present, then the criteria should be a fourfold rise in titer. Std test nearby Paauhau. When a titer of nontreponemal test <1:8, the test should be repeated and a treponemal test should also be performed.
The diagnosis of congenital syphilis is complicated by the trans-placental transfer of maternal nontreponemal and treponemal IgG antibodies to the fetus. This transfer of antibodies makes the interpretation of reactive serologic tests for syphilis in infants difficult. Treatment decisions frequently must be made on the basis of (1) identification of syphilis in the mother; (2) adequacy of maternal treatment; (3) presence of clinical, laboratory, or radiographic evidence of syphilis in the infant; and (4) comparison of maternal (at delivery) and infant nontreponemal serologic titers using the same test and preferably the same laboratory. Venous blood from both the mother and the child should be tested. Asymptomatic congenital syphilis requires a comprehensive approach. All infants born to mothers who have reactive nontreponemal and treponemal test results should be evaluated with a quantitative nontreponemal serologic test (RPR or VDRL) performed on infant serum because umbilical cord blood can become contaminated with maternal blood and could yield a false-positive result and should be examined thoroughly for evidence of congenital syphilis (e.g., nonimmune hydrops, jaundice, hepatosplenomegaly, rhinitis, skin rash, and/or pseudo paralysis of an extremity). Conducting a treponemal test (i.e., TP-PA or FTA-ABS) on a newborn's serum is not necessary.
Standard parameters of neurosyphilis on CSF examination include mononuclear cell count greater than 5-10 cells/mm3, protein concentration greater than 40 mg/dL, and a reactive CSF-VDRL. 3 Although regarded as the gold standard for the diagnosis of neurosyphilis, the VDRL-CSF, the standard serological test for CSF, is highly specific but is not 100% sensitive, may be negative in up to 50% of samples from patients with neurosyphilis. 10 , 11 Therefore, a negative VDRL-CSF result does not rule out neurosyphilis. Hawaii, United States Std Test. A reactive CSF-VDRL test, free of blood or other contaminants, usually indicates past or present syphilis infection of the central nervous system (CNS). A BFP test result is rare in spinal fluid. A nonreactive VDRL test may indicate that the patient does not have neurosyphilis. However, a negative result can occur in some patients with neurosyphilis. CSF treponemal test have high sensitivity and are helpful only when test is negative. A nonreactive test probably excludes neurosyphilis, but a positive test is not always diagnostic for neurosyphilis. However, in a patient co-infected with HIV and syphilis, it is difficult to diagnose neurosyphilis on the basis of CSF changes. In this case, testing of deoxyribonucleic acid (DNA) by PCR is an evolving technique that may be helpful. A reactive CSF-VDRL test or abnormal CSF indices that cannot be attributed to other ongoing illness requires re-treatment for possible neurosyphilis.
To limit unnecessary VDRL-CSF tests, a patient's serum should be reactive in a treponemal test before being accepted for VDRL-CSF testing. The fluorescent treponemal antibody-absorption double staining FTA-ABS (DS) test is used for confirmation of the present or past infections. FTA-ABS (DS) test is performed only if specifically requested, and serum shows some degree of reactivity to a nontreponemal test. For patients with neurosyphilis, repeat serologic testing and CSF examinations at 6-month intervals are recommended until the findings have stabilized. Paauhau Hawaii std test. Abnormal white blood cell count and protein level in the CSF should decrease by 6 months if no coexisting CNS infections are present, but CSF-VDRL test results may remain reactive for at least 2 years. If the CSF white blood cell count is not normal or the CSF-VDRL remains reactive at 2 years, and if no other cause is identified, then the patient should be re-evaluated and re-treated for neurosyphilis. In conclusion, it seems that the Treponema pallidum particle agglutination technique () can be used in CSF to diagnose neurosyphilis, although as for other serological tests, interpretation of results should be done in conjunction with other neurosyphilis parameters.
Serologic tests for syphilis are the cornerstone of diagnosing untreated syphilis infection, independent of HIV status. Nontreponemal assays, such as the RPR card or VDRL test, use cardiolipin-, lecithin-, and cholesterol-containing antigen to measure antilipoidal antibodies and are often used initially to diagnose syphilis. The sensitivity of nontreponemal and treponemal tests for syphilis increases with duration of infection, and ranges from approximately 75% in the primary stage to virtually 100% in the secondary stage. Because the sensitivity of nontreponemal tests is lower that that of treponemal tests in the primary stage, a negative nontreponemal test in an HIV-infected individual with a genital lesion cannot exclude primary syphilis. It may be useful to consider both a nontreponemal and a (nonreflexed) treponemal test as a diagnostic strategy in newly infected persons with suspicious lesions. Unusual serologic responses have been reported in HIV-infected persons with syphilis. Most reports involved higher than expected serologic titers, but false-negative serologic results and delayed appearance of sero-reactivity have also been reported, albeit rarely. Nevertheless, serologic tests appear to be accurate and reliable for the diagnosis of syphilis and the evaluation of treatment response in most HIV-infected patients. The clinician should seek confirmatory evidence for the diagnosis from any available source, including the patient's history, clinical findings, direct examination of lesion material for spirochetes, and serologic tests for syphilis. Reports of nontreponemal antibody test results should be quantitative and describe the lowest dilution (i.e., the titer) at which the test result is reactive. In general, nontreponemal test titers may be higher among HIV-positive patients than among HIV-negative persons. 12
The interaction of syphilis and HIV infection is complex and remains the subject of ongoing research. Although case reports have suggested that coexisting HIV infection may alter the natural history of syphilis, only a few such effects have been demonstrated in large observational studies. 13 , 14 The diagnosis of syphilis may be more complicated in the HIV-infected patients. Initial serologic responses to early syphilis were shown to be generally equivalent in HIV-negative and HIV-positive patients. 15 Reports of false-positive and false-negative results on serologic tests for syphilis in HIV-infected persons raise questions regarding the specificity and sensitivity of serologic diagnoses in such patients. 16 , 17 Unusual serological responses have been reported in syphilis, namely, higher than expected serologic VDRL titers, 12 , 18 - 20 but false-negative serologic result or delayed appearances of seroreactivity have also been reported. Nevertheless, both treponemal and nontreponemal serologic tests for syphilis are accurate in the majority of patients with syphilis and HIV co-infection. 20 The incidence of the prozone phenomenon could be expected to be higher in the HIV-infected population and always recommended to test for prozone phenomena. 21 The diagnosis of neurosyphilis in the individual infected with HIV can be difficult. The sensitivity of the CSF-VDRL can vary widely, and the treponemal tests (microhemagglutination (MHA) assay for T. pallidum (MHA-TP) and the FTA) lack specificity for neurosyphilis.
Irrespective of sign and symptoms, all HIV-positive patients should have baseline VDRL screening and follow-up at 3 months to rule out the possibility of false-negative results, as seroconversion generally takes about 4-6 weeks after infection. In the course of reactive VDRL, the diagnosis of syphilis should be confirmed by the specific treponemal test, namely FTA-ABS or TPHA should be done along with VDRL. Reactive minimal reaction in the FTA-ABS (DS) test provides evidence for or against syphilis. Std Test nearby Paauhau, HI. Beaded reaction in the FTA-ABS (DS) is most often associated with chronic inflammatory diseases. Repeat testing is indicated in both instances. If test results are still equivocal, a MHA test may be requested from CDC.
HIV is considered to be one of the important causes of false-positive reaction to syphilis serology; but this conception needs to be reinterpreted as most of the studies on syphilis serology in HIV positives have used populations that include those involved in IV drug use, a behavior that is an independent risk factor for false-positive serology. Further prospective study on the HIV-infected patients with biological false-reactive VDRL results to assess the seroconversion pattern and possible silent abnormality is recommended.
Std Test nearest Paauhau, HI. There is no ideal test of cure of syphilis available that can be carried out within days or weeks after treatment to determine the status of a patient. Patients should have serological tests for syphilis done on the day treatment is initiated. To access it, the patient is asked to repeat quantitative nontreponemal serological testing like VDRL/RPR and clinical evaluation at 3, 6, and 12 months. When serological test is negative, patient is assured to be cured. Generally, seropositivity is achieved in majority of the patients with primary syphilis in about 12 months after the treatment and in those with secondary syphilis in about 24 months. Seroconversion is more rapid after therapy if duration of infection is short and initial titer is low. As seroconversion is a slow process requiring months to years, the rate of decline is a better indicator of therapeutic response. A 4-fold decrease in titer is considered as good response, and this should occur within 3-6 months after therapy in patients with primary and secondary syphilis and within 12 months in patients with early latent syphilis. The VDRL titer may not decrease in patients with late syphilis and remains reactive at a low level (<1:8) for many years after adequate treatment. There is no satisfactory monitoring test available for nontreponemal test-negative late disease. 10
Nontreponemal tests are then monitored at a 6-month interval in patients with latent disease without neurosyphilis to document a fourfold decrease/seronegativity within 24 months after treatment. Low titers will persist in approximately 50% of patients with late syphilis after adequate therapy after 2 years. 22 This low titer persistent seropositivity does not signify treatment failure or reinfection, and these patients are likely to remain serofast even if they are retreated. The FTA-abs (DS) is not recommended for treatment follow-up. Nonreactive serologic tests and normal clinical evaluation cannot exclude incubating syphilis.
Syphilis has been referred to as the great imitator due to its wide variety of clinical presentations. Therefore, prompt diagnosis and treatment are essential not only to lower transmission rates, but also to avoid the complications seen in the later stages of the disease. However, when test result that is to be conveyed to the patient in a community where a limited resource is available, we need to inform the patient that a definitive diagnosis is only possible by performing, dark field examinations and direct fluorescent antibody (DFA) test. VDRL is just one of the tests to make an presumptive diagnosis. The use of only one type of serologic test is insufficient for diagnosis, because false-positive nontreponemal test results are sometimes associated with various medical conditions and situations unrelated to syphilis as mentioned above. T. pallidum may be visualized using dark ground microscopy, but the presence of spirochetes may be difficult to demonstrate, particularly if the patient has received recent antibiotic therapy. It is not easily cultured, and cannot grow on artificial media. Therefore, the diagnosis of infection is commonly performed using the VDRL and TPHA tests. Std Test near HI. This is a nonspecific test but it is useful in following treatment, since the antibody titer declines on successful therapy. Std Test closest to Paauhau. It also impresses on nonvenereologists the need to cautiously order and interpret serological tests for the demonstration of syphilis. This subsumes quantifying the VDRL among the infected, and the use of modern tests to determine the intensity of syphilitic process. In general, the sensitivity of treponemal tests continues to approximate 100% in late syphilis, in contrast to nontreponemal tests, which are more practical and cost-effective for initial screening but have diminished sensitivity in late syphilis. Despite the higher sensitivity of treponemal tests, they have not been recommended for initial screening in the many countries, primarily because of cost.
Late, tertiary syphilis—if untreated, secondary syphilis may continue into a latent stage, during which an infected person has no symptoms but continues to have the infection, and this stage can last for years. If still untreated, about 15% of people will develop the complications of late, or tertiary, syphilis. In these cases, the bacteria can damage the heart, eyes, brain, nervous system, bones, joints, or almost any other part of the body. When the central nervous system is affected, it is called neurosyphilis. Tertiary syphilis can last for years, with the final stage leading to mental illness, blindness, other neurological problems, heart disease , and death.
VDRL is a blood test that detects antibodies to the bacterium Treponema pallidum in the blood, body fluid, or tissue. This bacteria cause's syphilis infection which is a sexually transmitted disease that infects the genital area, lips, mouth, or anus of both men and women. It may also pass on from mother to baby during pregnancy. A syphilis infection can spread through the bloodstream to all parts of the body. If not treated, syphilis can cause severe heart disease, brain damage, spinal cord damage, blindness, and death.
The MHA-TP is used to confirm a syphilis infection after another method tests positive for the syphilis bacteria. The MHA-TP test detects antibodies to the bacteria that cause syphilis and can be used to detect syphilis in all stages, except during the first 3 to 4 weeks. Std Test near Paauhau Hawaii. This test is not done on spinal fluid. Std test closest to Paauhau. The MHA-TP test is rarely used any more. 4 Treponema pallidum particle agglutination assay (TP-PA), and the Toluidine red unheated serum test (TRUST) which may be used to confirm a positive VDRL result.
Nontreponemal antibody tests-these tests are called "nontreponemal" because they detect antibodies that are not specifically directed against the Treponema pallidum bacterium. These antibodies are produced by the body when an individual has syphilis but may also be produced in several other conditions. The tests are highly sensitive but, since they are non-specific, false-positive results can be caused by, for example, IV drug use, pregnancy , Lyme disease , certain types of pneumonia , malaria , tuberculosis , or certain autoimmune disorders including lupus A positive screening result must be confirmed with a more specific (treponemal) test. Std test near Paauhau. Nontreponemal tests include:
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