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Chapter 11.5 : Laboratory Diagnosis of Syphilis

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Laboratory Diagnosis of Syphilis, Page 1 of 2

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Abstract:

Syphilis is a sexually transmitted disease that is caused by the organism Treponema pallidum subsp. pallidum. The disease goes through several stages if untreated ( ). The primary chancre occurs at the site of inoculation approximately 3 to 4 weeks (range, 10 to 90 days) after the initial exposure. Treponemes may be visualized in lesion exudates using either dark-field microscopy or direct fluorescent antibody for T. pallidum (DFA-TP). About 7 to 10 days after the chancre appears, antibodies to T. pallidum are detectable using the routine serologic tests for syphilis. The chancre spontaneously heals after 1 to 4 weeks. The symptoms of secondary syphilis appear about 6 weeks later (range, 2 weeks to 6 months). All serologic tests are generally reactive during secondary syphilis. The most common symptoms are a generalized or localized maculopapular rash that occurs on the palms of the hands and soles of the feet (palmar plantar rash) or on the trunk of the body, mucosal membrane lesions, generalized lymphadenopathy, and condylomata lata. These symptoms will resolve without treatment. The patient then enters a period of latency when there are no symptoms. In about 20 to 25% of individuals, secondary symptoms may reoccur during the early part of this latent period. In early latency (<1 year) the results for the serologic tests for syphilis are reactive. As patients progress into late latency, the nontreponemal tests may become nonreactive, but the treponemal tests will remain reactive. About 65% of persons with untreated syphilis will remain in this stage for life ( ). In the remaining 35%, late manifestations of syphilis will occur.

Citation: Garcia L. 2010. Laboratory Diagnosis of Syphilis, p 160-172. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch11.5
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References

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1. Augenbraun, M.,, R. Rolfs,, R. Johnson,, R. Joesoef,, V. Pope, and the Syphilis and HIV Study Group. 1998. Treponemal specific tests for the serodiagnosis of syphilis. Sex. Transm. Dis. 25:549552.
2.Centers for Disease Control. 1988. Recommendation for diagnosing and treating syphilis in HIV-infected patients. MMWR Morb. Mortal. Wkly. Rep. 37:600602, 607608.
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4. Hough, M. K.,, and J. A. Poppe. 1988. Sexually transmitted diseases; a policymaker’s guide and summary of state laws. National Conference of State Legislatures, Denver, CO.
5. Jaffe, H. W.,, S. A. Larsen,, M. Peters,, D. F. Jove,, B. Lopez,, and A. L. Schroeter. 1978. Tests for treponemal antibody in CSF. Arch. Intern. Med. 138:252255.
6. Joyanes, P.,, M. V. Borobio,, J. M. Arquez,, and E. J. Perea. 1998. The association of false-positive rapid plasma reagin results and HIV infection. Sex. Transm. Dis. 25:569571.
7. Larsen, S. A.,, B. E. McGrew,, E. F. Hunter,, and E. T. Creighton,. 1984. Syphilis serology and dark-field microscopy, p. 875888. In K. K. Holmes,, P.-A. Maårdh,, P. F. Sparling,, and P. J. Wiesner (ed.), Sexually Transmitted Diseases. McGraw-Hill Book Co., New York, NY.
8. Larsen, S. A.,, V. Pope,, R. E. Johnson,, and E. J. Kennedy, Jr. (ed.). 1998. A Manual of Tests for Syphilis, 9th ed. American Public Health Association, Washington, DC.
9. Larsen, S. A.,, B. M. Steiner,, and A. H. Rudolph. 1998. Laboratory diagnosis and interpretation of tests for syphilis. Clin. Microbiol. Rev. 8:121.
10. Peterman, T.,, J. Schillinger,, S. Blank,, S. Berman,, R. Ballard,, D. Cox,, R. Johnson,, S. Hariri,, and N. Selvam. 2008. Syphilis testing algorithms using treponemal tests for initial screening—four laboratories, New York City, 2005-2006. MMWR Morb. Mortal. Wkly. Rep. 57:872875.
11. Pope, V.,, M. B. Fears,, W. E. Morrill,, A. Castro,, and S. E. Kikkert. 2000. Comparison of the Serodia Treponema pallidum particle agglutination, Captia Syphilis-G, and SpiroTek Reagin II tests with standard test techniques for diagnosis of syphilis. J. Clin. Microbiol. 38:25432545.
12. Rolfs, R. T.,, M. R. Joesoef,, E. F. Hendershot,, A. M. Rompalo,, M. H. Augenbraun,, M. Chiu,, G. Bolan,, S. C. Johnson,, P. French,, E. Steen,, J. D. Radolf,, and S. Larsen for the Syphilis and HIV Study Group. 1997. A randomized trial of enhanced therapy for early syphilis in patients with and without human immunodeficiency virus infection. N. Engl. J. Med. 337:307314.
13. Romanowski, B.,, R. Sutherland,, G. H. Fick,, D. Mooney,, and E. G. Love. 1991. Serologic response to treatment of infectious syphilis. Ann. Intern. Med. 114:10051009.
14. Singh, A. E.,, and B. Romanowski. 1999. Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features. Clin. Microbiol. Rev. 12:187209.
15.Venereal Disease Program. 1968. Syphilis: a synopsis. U.S. Department of Health, Education and Welfare. National Communicable Disease Center, Atlanta, GA.
16. Wicher, K.,, H. W. Horowitz,, and V. Wicher. 1999. Laboratory methods of diagnosis of syphilis for the beginning of the third millennium. Microbes Infect. 1:10351049.
1. Larsen, S. A.,, V. Pope,, R. E. Johnson,, and E. J. Kennedy, Jr. (ed.). 1998. A Manual of Tests for Syphilis, 9th ed. American Public Health Association, Washington, DC.
2. Larsen, S. A.,, B. M. Steiner,, and A. H. Rudolph. 1995. Laboratory diagnosis and interpretation of tests for syphilis. Clin. Microbiol. Rev. 8:121.
1. Bossak, H. N.,, A. Harris,, and S. Olansky. 1955. Effect of room temperature on serologic tests for syphilis. Br. J. Vener. Dis. 31:3336.
2.Centers for Disease Control. 1987 Update on hepatitis B prevention. Morb. Mortal Wkly. Rep. 36:353360, 366.
3.Centers for Disease Control. 1988. Update: universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other blood-borne pathogens in health care settings. Morb. Mortal. Wkly. Rep. 37:600602, 607608.
4. Larsen, S. A.,, V. Pope,, R. E. Johnson,, and E. J. Kennedy, Jr. (ed.). 1998. A Manual of Tests for Syphilis, 9th ed. American Public Health Association, Washington, DC.
1.Centers for Disease Control. 1987. Update on hepatitis B prevention. MMWR Morb. Mortal. Wkly. Rep. 36:353360, 366.
2.Centers for Disease Control. 1988. Update: universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other blood-borne pathogens in health care settings. MMWR Morb. Mortal. Wkly. Rep. 37:377383, 387388.
3. Larsen, S. A.,, V. Pope,, R. E. Johnson,, and E. J. Kennedy, Jr. (ed). 1998. A Manual of Tests for Syphilis, 9th ed. American Public Health Association, Washington, DC.
4. Pope, V.,, M. B. Fears,, W. E. Morrill,, A. Castro,, and S. E. Kikkert. 2000. Comparison of the Serodia Treponema pallidum particle agglutination, Captia Syphilis-G, and SpiroTek Reagin II tests with standard test techniques for diagnosis of syphilis. J. Clin. Microbiol. 38:25432545.

Tables

Generic image for table
Table 11.5.1-1a

List of suppliers for syphilis diagnostic tests

Citation: Garcia L. 2010. Laboratory Diagnosis of Syphilis, p 160-172. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch11.5
Generic image for table
Table 11.5.1-1b

List of suppliers for syphilis diagnostic tests

Citation: Garcia L. 2010. Laboratory Diagnosis of Syphilis, p 160-172. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch11.5
Generic image for table
Table 11.5.3-1

Reporting quantitative RPR test results

Abbreviations: N, nonreactive; R, reactive; Rm, reactive minimal.

Citation: Garcia L. 2010. Laboratory Diagnosis of Syphilis, p 160-172. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch11.5
Generic image for table
Table 11.5.4-1

Interpretation of agglutination pattern sintheTP-PA

Citation: Garcia L. 2010. Laboratory Diagnosis of Syphilis, p 160-172. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch11.5

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