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==Overview== | |||
Laboratory tests which may help diagnose syphilis include [[Darkfield microscope|darkfield examinations]] and tests to detect ''[[T. pallidum]]'' in lesion exudate or tissue, [[PCR]], nontreponemal (e.g., [[VDRL|venereal disease research laboratory (VDRL)]] and [[RPR|rapid plasma reagent test]]) and treponemal tests (e.g., [[FTA-ABS|fluorescent treponemal antibody absorbed (FTA-ABS) tests]], the ''T. pallidum'' passive particle agglutination (TP-PA) assay, various [[Enzyme linked immunosorbent assay (ELISA)|enzyme immunoassays]], and [[Chemiluminescence|chemiluminescence immunoassays]]). Abnormalities in the [[CSF]] consistent with disease include; [[Pleocytosis]], often lymphocytic predominant, mild protein elevation and positive [[CSF]] [[VDRL]]. | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
=== Diagnostic tests for confirming syphilis infection in a newly admitted patient === | |||
Laboratory tests which may help diagnose [[syphilis]] include the following:<ref name="CDC2016">http://www.cdc.gov/std/tg2015/syphilis.htm Accessed on September 28th, 2016</ref><ref name="pmid18159528">{{cite journal| author=Ratnam S| title=The laboratory diagnosis of syphilis. | journal=Can J Infect Dis Med Microbiol | year= 2005 | volume= 16 | issue= 1 | pages= 45-51 | pmid=18159528 | doi= | pmc=2095002 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18159528 }} </ref><ref name="pmid25428245">{{cite journal| author=Morshed MG, Singh AE| title=Recent trends in the serologic diagnosis of syphilis. | journal=Clin Vaccine Immunol | year= 2015 | volume= 22 | issue= 2 | pages= 137-47 | pmid=25428245 | doi=10.1128/CVI.00681-14 | pmc=4308867 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25428245 }} </ref><ref name="pmid22942884">{{cite journal| author=Tsang RS, Radons SM, Morshed M| title=Laboratory diagnosis of syphilis: A survey to examine the range of tests used in Canada. | journal=Can J Infect Dis Med Microbiol | year= 2011 | volume= 22 | issue= 3 | pages= 83-7 | pmid=22942884 | doi= | pmc=3200370 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22942884 }} </ref><ref name="pmid25428245">{{cite journal| author=Morshed MG, Singh AE| title=Recent trends in the serologic diagnosis of syphilis. | journal=Clin Vaccine Immunol | year= 2015 | volume= 22 | issue= 2 | pages= 137-47 | pmid=25428245 | doi=10.1128/CVI.00681-14 | pmc=4308867 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25428245 }} </ref><ref name="pmid24278076">{{cite journal| author=Pastuszczak M, Wojas-Pelc A| title=Current standards for diagnosis and treatment of syphilis: selection of some practical issues, based on the European (IUSTI) and U.S. (CDC) guidelines. | journal=Postepy Dermatol Alergol | year= 2013 | volume= 30 | issue= 4 | pages= 203-10 | pmid=24278076 | doi=10.5114/pdia.2013.37029 | pmc=3834708 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24278076 }} </ref> | |||
*[[Dark field microscopy|Darkfield]] examinations and tests to detect ''[[T. pallidum]]'' in lesion [[exudate]] or tissue are the definitive methods for diagnosing early [[syphilis]]. | |||
* | *Although no ''[[T. pallidum]]'' detection tests are commercially available, some laboratories provide locally developed [[PCR]] tests for the detection of [[T. pallidum|''T. pallidum''.]] | ||
* | |||
* | *A presumptive diagnosis of [[syphilis]] is possible with the use of two types of serologic tests: | ||
**FTA-ABS | :*Nontreponemal tests (e.g., [[VDRL|venereal disease research laboratory (VDRL)]] and [[RPR|rapid plasma reagent test]]) | ||
** | :*Treponemal tests (e.g., [[FTA-ABS|fluorescent treponemal antibody absorbed (FTA-ABS) tests]], the ''[[T. pallidum]]'' passive particle agglutination (TP-PA) assay, various [[Enzyme linked immunosorbent assay (ELISA)|enzyme immunoassays]], and [[Chemiluminescence|chemiluminescence immunoassays]]). | ||
*The use of only one type of [[serologic]] test is insufficient for diagnosis because each type of test has limitations, including the possibility of false-positive test results in persons without [[syphilis]]. | |||
*False-positive nontreponemal test results can be associated with various medical conditions unrelated to [[syphilis]], including [[Autoimmune|autoimmune conditions]], older age, and injection-drug use.<ref name="pmid7548285">{{cite journal |author=Nandwani R, Evans DT |title=Are you sure it's syphilis? A review of false positive serology |journal=[[International Journal of STD & AIDS]] |volume=6 |issue=4 |pages=241–8 |year=1995 |pmid=7548285 |doi= |url= |accessdate=2012-02-16}}</ref><ref name="urlwww.aphl.org">{{cite web |url=http://www.aphl.org/aphlprograms/infectious/std/Documents/LaboratoryGuidelinesTreponemapallidumMeetingReport.pdf |title=www.aphl.org |format= |work= |accessdate=2012-12-19}}</ref> Therefore, persons with a reactive nontreponemal test should receive a treponemal test to confirm the diagnosis of [[syphilis]]. | |||
===Nontreponemal test=== | |||
*Includes [[Venereal disease research laboratory (VDRL) test|VDRL]] and [[Rapid plasma reagent|RPR]] tests. | |||
*[[Antibody]] titers may correlate with disease activity. | |||
*May reverse following treatment. | |||
*Used to follow treatment response. | |||
*A fourfold change in titer is necessary to demonstrate significant difference between two nontreponemal tests. | |||
*Results from two tests cannot be compared directly with each other. | |||
===Trepenomal tests === | |||
*Include [[FTA-ABS|fluorescent treponemal antibody absorbed (FTA-ABS) tests]], ''[[T. pallidum]]'' passive particle agglutination (TP-PA) assay, [[Enzyme linked immunosorbent assay (ELISA)|enzyme immunoassays]], and [[Chemiluminescence|chemiluminescence immunoassays]]. | |||
*[[Antibody titer]]<nowiki/>s, once positive, remain positive for the rest of the patient's life, regardless of treatment or disease activity. | |||
*Cannot be used for monitoring treatment response. | |||
*Screening using trepenomal tests may help identify individuals previously treated for [[syphilis]], those with untreated or incompletely treated [[syphilis]], and persons with false-positive results. | |||
=== Diagnostic tests for specifying neurosyphilis === | |||
[[Neurosyphilis]] is often initially suspected based on clinical findings with positive serologic tests and finally confirmed through [[Lumbar puncture|lumbar puncture (LP)]]. | |||
Abnormalities in the [[CSF]] consistent with disease include:<ref name="pmid27606153">{{cite journal| author=Henao-Martínez AF, Johnson SC| title=Diagnostic tests for syphilis: New tests and new algorithms. | journal=Neurol Clin Pract | year= 2014 | volume= 4 | issue= 2 | pages= 114-122 | pmid=27606153 | doi=10.1212/01.CPJ.0000435752.17621.48 | pmc=4999316 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27606153 }} </ref> | |||
* [[Pleocytosis]], often [[lymphocytic]] predominant | |||
* Mild protein elevation | |||
* Positive [[Venereal disease research laboratory (VDRL) test|VDRL]] | |||
* CSF [[Fluorescent treponemal antibody absorbtion (FTA-ABS) test|FTA-ABS]] can be used but is not specific | |||
CSF abnormalities alone can not make or rule out the diagnosis of [[neurosyphilis]]. Every result should be placed in context with the clinical scenario and special finding in imaging and laboratory tests of each patient. | |||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
Laboratory tests which may help diagnose syphilis include darkfield examinations and tests to detect T. pallidum in lesion exudate or tissue, PCR, nontreponemal (e.g., venereal disease research laboratory (VDRL) and rapid plasma reagent test) and treponemal tests (e.g., fluorescent treponemal antibody absorbed (FTA-ABS) tests, the T. pallidum passive particle agglutination (TP-PA) assay, various enzyme immunoassays, and chemiluminescence immunoassays). Abnormalities in the CSF consistent with disease include; Pleocytosis, often lymphocytic predominant, mild protein elevation and positive CSF VDRL.
Laboratory Findings
Diagnostic tests for confirming syphilis infection in a newly admitted patient
Laboratory tests which may help diagnose syphilis include the following:[1][2][3][4][3][5]
- Darkfield examinations and tests to detect T. pallidum in lesion exudate or tissue are the definitive methods for diagnosing early syphilis.
- Although no T. pallidum detection tests are commercially available, some laboratories provide locally developed PCR tests for the detection of T. pallidum.
- A presumptive diagnosis of syphilis is possible with the use of two types of serologic tests:
- Nontreponemal tests (e.g., venereal disease research laboratory (VDRL) and rapid plasma reagent test)
- Treponemal tests (e.g., fluorescent treponemal antibody absorbed (FTA-ABS) tests, the T. pallidum passive particle agglutination (TP-PA) assay, various enzyme immunoassays, and chemiluminescence immunoassays).
- The use of only one type of serologic test is insufficient for diagnosis because each type of test has limitations, including the possibility of false-positive test results in persons without syphilis.
- False-positive nontreponemal test results can be associated with various medical conditions unrelated to syphilis, including autoimmune conditions, older age, and injection-drug use.[6][7] Therefore, persons with a reactive nontreponemal test should receive a treponemal test to confirm the diagnosis of syphilis.
Nontreponemal test
- Includes VDRL and RPR tests.
- Antibody titers may correlate with disease activity.
- May reverse following treatment.
- Used to follow treatment response.
- A fourfold change in titer is necessary to demonstrate significant difference between two nontreponemal tests.
- Results from two tests cannot be compared directly with each other.
Trepenomal tests
- Include fluorescent treponemal antibody absorbed (FTA-ABS) tests, T. pallidum passive particle agglutination (TP-PA) assay, enzyme immunoassays, and chemiluminescence immunoassays.
- Antibody titers, once positive, remain positive for the rest of the patient's life, regardless of treatment or disease activity.
- Cannot be used for monitoring treatment response.
- Screening using trepenomal tests may help identify individuals previously treated for syphilis, those with untreated or incompletely treated syphilis, and persons with false-positive results.
Diagnostic tests for specifying neurosyphilis
Neurosyphilis is often initially suspected based on clinical findings with positive serologic tests and finally confirmed through lumbar puncture (LP).
Abnormalities in the CSF consistent with disease include:[8]
- Pleocytosis, often lymphocytic predominant
- Mild protein elevation
- Positive VDRL
- CSF FTA-ABS can be used but is not specific
CSF abnormalities alone can not make or rule out the diagnosis of neurosyphilis. Every result should be placed in context with the clinical scenario and special finding in imaging and laboratory tests of each patient.
References
- ↑ http://www.cdc.gov/std/tg2015/syphilis.htm Accessed on September 28th, 2016
- ↑ Ratnam S (2005). "The laboratory diagnosis of syphilis". Can J Infect Dis Med Microbiol. 16 (1): 45–51. PMC 2095002. PMID 18159528.
- ↑ 3.0 3.1 Morshed MG, Singh AE (2015). "Recent trends in the serologic diagnosis of syphilis". Clin Vaccine Immunol. 22 (2): 137–47. doi:10.1128/CVI.00681-14. PMC 4308867. PMID 25428245.
- ↑ Tsang RS, Radons SM, Morshed M (2011). "Laboratory diagnosis of syphilis: A survey to examine the range of tests used in Canada". Can J Infect Dis Med Microbiol. 22 (3): 83–7. PMC 3200370. PMID 22942884.
- ↑ Pastuszczak M, Wojas-Pelc A (2013). "Current standards for diagnosis and treatment of syphilis: selection of some practical issues, based on the European (IUSTI) and U.S. (CDC) guidelines". Postepy Dermatol Alergol. 30 (4): 203–10. doi:10.5114/pdia.2013.37029. PMC 3834708. PMID 24278076.
- ↑ Nandwani R, Evans DT (1995). "Are you sure it's syphilis? A review of false positive serology". International Journal of STD & AIDS. 6 (4): 241–8. PMID 7548285.
|access-date=requires|url=(help) - ↑ "www.aphl.org" (PDF). Retrieved 2012-12-19.
- ↑ Henao-Martínez AF, Johnson SC (2014). "Diagnostic tests for syphilis: New tests and new algorithms". Neurol Clin Pract. 4 (2): 114–122. doi:10.1212/01.CPJ.0000435752.17621.48. PMC 4999316. PMID 27606153.