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Chapter 46 : Laboratory Diagnosis of Syphilis

Author: John L. Schmitz1
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Affiliations: 1: University of North Carolina, Department of Pathology & Laboratory Medicine, School of Medicine, Rm. 1035 East Wing, UNC Hospitals, Chapel Hill, NC 27514
Content Type: Reference
Publication Year: 2016

Category: Immunology

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Abstract:

The laboratory diagnosis of syphilis has relied, in large part, upon serologic methods for over 100 years (1). The causative organism, , is not amenable to culture, and antigen detection and nucleic acid amplification techniques have not become routinely used. While many of the serologic methods in use now have been in use for decades, their application, specifically the standard testing algorithm, is changing. In order to understand the interpretation of alternative testing algorithms, a thorough understanding of test characteristics is necessary. This chapter will review serologic tests for syphilis and their interpretation when they are applied to adults with and without HIV infection and to children.

Citation: Schmitz J. 2016. Laboratory Diagnosis of Syphilis, p 412-418. In Detrick B, Schmitz J, Hamilton R (ed), Manual of Molecular and Clinical Laboratory Immunology, Eighth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818722.ch46
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Laboratory Diagnosis of Syphilis
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Citation: Schmitz J. 2016. Laboratory Diagnosis of Syphilis, p 412-418. In Detrick B, Schmitz J, Hamilton R (ed), Manual of Molecular and Clinical Laboratory Immunology, Eighth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818722.ch46
/content/10.1128/9781555818722.ch46.ch46fig1
FIGURE 1

Traditional algorithm.

10.1128/9781555818722/8722ch46fig1_thmb.gif
10.1128/9781555818722/8722ch46fig1.gif
Image of FIGURE 1
FIGURE 1

Traditional algorithm.

Citation: Schmitz J. 2016. Laboratory Diagnosis of Syphilis, p 412-418. In Detrick B, Schmitz J, Hamilton R (ed), Manual of Molecular and Clinical Laboratory Immunology, Eighth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818722.ch46
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FIGURE 2

Reverse algorithm. *, may indicate a false-positive screening test result; however, a very sensitive screening test, such as CLIA, might be positive when the standard treponemal test is nonreactive.

10.1128/9781555818722/8722ch46fig2_thmb.gif
10.1128/9781555818722/8722ch46fig2.gif
Image of FIGURE 2
FIGURE 2

Reverse algorithm. *, may indicate a false-positive screening test result; however, a very sensitive screening test, such as CLIA, might be positive when the standard treponemal test is nonreactive.

Citation: Schmitz J. 2016. Laboratory Diagnosis of Syphilis, p 412-418. In Detrick B, Schmitz J, Hamilton R (ed), Manual of Molecular and Clinical Laboratory Immunology, Eighth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818722.ch46
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References

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1. Wassermann AANCB . 1906. Eine serodiagnostische Reaktion bei Syphilis. Dtsch Med Wochenschr 32 : 745– 746.[CrossRef]
2. Patton ME, Su JR, Nelson R, Weinstock H . 2014. Primary and secondary syphilis—United States, 2005–2013. MMWR Morb Mortal Wkly Rep 63 : 402– 406.[PubMed]
3. Walker DG, Walker GJ . 2004. Prevention of congenital syphilis—time for action. Bull World Health Organ 82 : 401.[PubMed]
4. Marangoni A, Sambri V, Cavrini F, Frabetti A, Storni E, Accardo S, Servidio D, Foschi F, Montebugnoli L, Prati C, Cevenini R . 2005. Treponema denticola infection is not a cause of false positive Treponema pallidum serology. New Microbiol 28 : 215– 221.[PubMed]
5. Hook EW III, Marra CM . 1992. Acquired syphilis in adults. N Engl J Med 326 : 1060– 1069.[CrossRef].[PubMed]
6. Zou S, Stramer SL, Dodd RY . 2012. Donor testing and risk: current prevalence, incidence, and residual risk of transfusion-transmissible agents in US allogeneic donations. Transfus Med Rev 26 : 119– 128.[CrossRef].[PubMed]
7. Tariciotti L, Das I, Dori L, Perera MT, Bramhall SR . 2012. Asymptomatic transmission of Treponema pallidum (syphilis) through deceased donor liver transplantation. Transpl Infect Dis 14 : 321– 325.[CrossRef].[PubMed]
8. Greenblatt RM, Lukehart SA, Plummer FA, Quinn TC, Critchlow CW, Ashley RL, D'Costa LJ, Ndinya-Achola JO, Corey L, Ronald AR, Holmes KK . 1988. Genital ulceration as a risk factor for human immunodeficiency virus infection. AIDS 2 : 47– 50.[PubMed].[CrossRef]
9. Palacios R, Jimenez-Onate F, Aguilar M, Galindo MJ, Rivas P, Ocampo A, Berenguer J, Arranz JA, Rios MJ, Knobel H, Moreno F, Ena J, Santos J . 2007. Impact of syphilis infection on HIV viral load and CD4 cell counts in HIV-infected patients. J Acquir Immune Defic Syndr 44 : 356– 359.[CrossRef].[PubMed]
10. Zellan J, Augenbraun M . 2004. Syphilis in the HIV-infected patient: an update on epidemiology, diagnosis, and management. Curr HIV/AIDS Rep 1 : 142– 147.[PubMed].[CrossRef]
11. Woods CR . 2005. Syphilis in children: congenital and acquired. Semin Pediatr Infect Dis 16 : 245– 257.[CrossRef].[PubMed]
12. Workowski KA, Berman S . 2010. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 59 : 1– 110.[PubMed]
13. Kennedy EJ, Creighton ET, . 1998. Dark field microscopy for the detection and identification of Treponema pallidum, p 118– 134. In Larsen SA, Pope V, Johnson RE, Kennedy EJ (ed), A Manual of Tests for Syphilis, 9th ed. American Public Health Association, Washington, DC.
14. Romanowski B, Forsey E, Prasad E, Lukehart S, Tam M, Hook EW III . 1987. Detection of Treponema pallidum by a fluorescent monoclonal antibody test. Sex Transm Dis 14 : 156– 159.[PubMed].[CrossRef]
15. George RW, Hunter EF, Fears MB, . 1998. Direct fluorescent antibody test for Treponema pallidum (DFA-TP), p 135– 146. In Larsen SA, Pope V, Johnson RE, Kennedy EJ (ed), A Manual of Tests for Syphilis, 9th ed. American Public Health Association, Washington, DC.
16. George RW, Hunter EF, Fears MB, . 1998. Direct fluorescent antibody tissue test for Treponema pallidum (DFAT-TP), p 147– 156. In Larsen SA, Pope V, Johnson RE, Kennedy EJ (ed), A Manual of Tests for Syphilis, 9th ed. American Public Health Association, Washington, DC.
17. Gayet-Ageron A, Lautenschlager S, Ninet B, Perneger TV, Combescure C . 2013. Sensitivity, specificity and likelihood ratios of PCR in the diagnosis of syphilis: a systematic review and meta-analysis. Sex Transm Infect 89 : 251– 256.[CrossRef].[PubMed]
18. Belisle JT, Brandt ME, Radolf JD, Norgard MV . 1994. Fatty acids of Treponema pallidum and Borrelia burgdorferi lipoproteins. J Bacteriol 176 : 2151– 2157.[PubMed]
19. Larsen SA, Pope V, Johnson RE, Kennedy EJ (ed). 1998. A Manual of Tests for Syphilis, 9th ed. American Public Health Association, Washington, DC.
20. Larsen SA, Steiner BM, Rudolph AH . 1995. Laboratory diagnosis and interpretation of tests for syphilis. Clin Microbiol Rev 8 : 1– 21.[PubMed]
21. Liu LL, Lin LR, Tong ML, Zhang HL, Huang SJ, Chen YY, Guo XJ, Xi Y, Liu L, Chen FY, Zhang YF, Zhang Q, Yang TC . 2014. Incidence and risk factors for the prozone phenomenon in serologic testing for syphilis in a large cohort. Clin Infect Dis 59 : 384– 389.[CrossRef].[PubMed]
22. Post JJ, Khor C, Furner V, Smith DE, Whybin LR, Robertson PW . 2012. Case report and evaluation of the frequency of the prozone phenomenon in syphilis serology—an infrequent but important laboratory phenomenon. Sex Health 9 : 488– 490.[CrossRef].[PubMed]
23. el-Zaatari MM, Martens MG, Anderson GD . 1994. Incidence of the prozone phenomenon in syphilis serology. Obstet Gynecol 84 : 609– 612.[PubMed]
24. Albright RE Jr, Christenson RH, Emlet JL, Graham CB III, Estevez EG, Wilson ML, Reller LB, Schneider KA . 1991. Issues in cerebrospinal fluid management. CSF Venereal Disease Research Laboratory testing. Am J Clin Pathol 95 : 397– 401.[PubMed].[CrossRef]
25. Workowski KA, Bolan GA . 2015. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 64 : 1– 137.[PubMed].[CrossRef]
26. Schmitz JL, Gertis KS, Mauney C, Stamm LV, Folds JD . 1994. Laboratory diagnosis of congenital syphilis by immunoglobulin M (IgM) and IgA immunoblotting. Clin Diagn Lab Immunol 1 : 32– 37.[PubMed]
27. Sena AC, Wolff M, Martin DH, Behets F, Van Damme K, Leone P, Langley C, McNeil L, Hook EW . 2011. Predictors of serological cure and serofast state after treatment in HIV-negative persons with early syphilis. Clin Infect Dis 53 : 1092– 1099.[CrossRef].[PubMed]
28. Tong ML, Lin LR, Liu GL, Zhang HL, Zeng YL, Zheng WH, Liu LL, Yang TC . 2013. Factors associated with serological cure and the serofast state of HIV-negative patients with primary, secondary, latent, and tertiary syphilis. PLoS One 8 : e70102.[CrossRef].[PubMed]
29. Hunter EF, Deacon WE, Meyer PE . 1964. An improved FTA test for syphilis, the absorption procedure (FTA-ABS). Public Health Rep 79 : 410– 412.[PubMed].[CrossRef]
30. George RW, Hunter EF, Fears MB, . 1998. Fluorescent treponemal antibody-absorption (FTA-ABS) test, p 223– 245. In Larsen SA, Pope V, Johnson RE, Kennedy EJ (ed), A Manual of Tests for Syphilis, 9th ed. American Public Health Association, Washington, DC.
31. Ozanne G, d'Halewyn MA, Larsen SA . 1993. Comparison of the fluorescent treponemal antibody absorption (FTA-ABS) test with the FTA-ABS double staining test for detection of antitreponemal immunoglobulin M in the 19S fraction of human serum. J Clin Microbiol 31 : 102– 106.[PubMed]
32. Nayar R, Campos JM . 1993. Evaluation of the DCL Syphilis-G enzyme immunoassay test kit for the serologic diagnosis of syphilis. Am J Clin Pathol 99 : 282– 285.[PubMed].[CrossRef]
33. Cole MJ, Perry KR, Parry JV . 2007. Comparative evaluation of 15 serological assays for the detection of syphilis infection. Eur J Clin Microbiol Infect Dis 26 : 705– 713.[CrossRef].[PubMed]
34. Sena AC, White BL, Sparling PF . 2010. Novel Treponema pallidum serologic tests: a paradigm shift in syphilis screening for the 21st century. Clin Infect Dis 51 : 700– 708.[CrossRef].[PubMed]
35. Lefevre JC, Bertrand, Andreo M, Gauthier G Groupe Etude et Prevention des Maladies Transmissibles, Sexuellement . 1989. Evaluation of an IgM antibody capture enzyme immunoassay Captia Syphilis-M in treated and untreated syphilis. J Chemother 1 : 898– 899.[PubMed]
36. Knight CS, Crum MA, Hardy RW . 2007. Evaluation of the LIAISON chemiluminescence immunoassay for diagnosis of syphilis. Clin Vaccine Immunol 14 : 710– 713.[CrossRef].[PubMed]
37. Castro RR, Prieto ES, Santo I, Azevedo J, Exposto FL . 2001. Evaluation of the passive particle agglutination test in the serodiagnosis and follow-up of syphilis. Am J Clin Pathol 116 : 581– 585.[CrossRef].[PubMed]
38. Pope V, Fears MB, . 1998. Serodia Treponema pallidum passive particle agglutination (TP-PA) test, p 365– 378. In Larsen SA, Pope V, Johnson RE, Kennedy EJ (ed), A Manual of Tests for Syphilis, 9th ed. American Public Health Association, Washington, DC.
39. Rathlev T . 1967. Haemagglutination test utilizing pathogenic Treponema pallidum for the sero-diagnosis of syphilis. Br J Vener Dis 43 : 181– 185.[PubMed].[CrossRef]
40. Davis LE, Sperry S . 1979. The CSF-FTA test and the significance of blood contamination. Ann Neurol 6 : 68– 69.[CrossRef].[PubMed]
41. Goldman JN, Lantz MA . 1971. FTA-ABS and VDRL slide test reactivity in a population of nuns. JAMA 217 : 53– 55.[PubMed].[CrossRef]
42. Kay NS, Peeling RW, Mabey DC . 2014. State of the art syphilis diagnostics: rapid point-of-care tests. Expert Rev Anti Infect Ther 12 : 63– 73.[CrossRef].[PubMed]
43. Low N, Broutet N, Adu-Sarkodie Y, Barton P, Hossain M, Hawkes S . 2006. Global control of sexually transmitted infections. Lancet 368 : 2001– 2016.[CrossRef].[PubMed]
44. Tucker JD, Bu J, Brown LB, Yin YP, Chen XS, Cohen MS . 2010. Accelerating worldwide syphilis screening through rapid testing: a systematic review. Lancet Infect Dis 10 : 381– 386.[CrossRef].[PubMed]
45. Centers for Disease Control and Prevention . 2011. Discordant results from reverse sequence syphilis screening—five laboratories, United States, 2006–2010. MMWR Morb Mortal Wkly Rep 60 : 133– 137.[PubMed]
46. Binnicker MJ, Jespersen DJ, Rollins LO . 2012. Direct comparison of the traditional and reverse syphilis screening algorithms in a population with a low prevalence of syphilis. J Clin Microbiol 50 : 148– 150.[CrossRef].[PubMed]
47. Gratrix J, Plitt S, Lee BE, Ferron L, Anderson B, Verity B, Prasad E, Bunyan R, Zahariadis G, Singh AE . 2012. Impact of reverse sequence syphilis screening on new diagnoses of late latent syphilis in Edmonton, Canada. Sex Transm Dis 39 : 528– 530.[CrossRef].[PubMed]
48. World Health Organization . 2008. Global Incidence and Prevalence of Selected Curable Sexually Transmitted Infections—2008. World Health Organization, Geneva, Switzerland. http://apps.who.int/iris/bitstream/10665/75181/1/9789241503839_eng.pdf?ua=1

Tables

Laboratory Diagnosis of Syphilis
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Citation: Schmitz J. 2016. Laboratory Diagnosis of Syphilis, p 412-418. In Detrick B, Schmitz J, Hamilton R (ed), Manual of Molecular and Clinical Laboratory Immunology, Eighth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818722.ch46
/content/10.1128/9781555818722.ch46.ch46tab1
TABLE 1

Nontreponemal serologic tests for syphilis

Generic image for table
TABLE 1

Nontreponemal serologic tests for syphilis

Citation: Schmitz J. 2016. Laboratory Diagnosis of Syphilis, p 412-418. In Detrick B, Schmitz J, Hamilton R (ed), Manual of Molecular and Clinical Laboratory Immunology, Eighth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818722.ch46
/content/10.1128/9781555818722.ch46.ch46tab2
TABLE 2

Common treponemal antibody tests

Generic image for table
TABLE 2

Common treponemal antibody tests

Citation: Schmitz J. 2016. Laboratory Diagnosis of Syphilis, p 412-418. In Detrick B, Schmitz J, Hamilton R (ed), Manual of Molecular and Clinical Laboratory Immunology, Eighth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818722.ch46

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