Fluorescent treponemal-antibody absorption tests. Studies of false-positive reactions to tests for syphilis

Cerebrospinal fluid proteins in neurosyphilis and HIV infection

This paper briefly reviews the factors which influence the concentrations of proteins, particularly immunoglobulins, within the CSF and how antibodies which are locally synthesized within the central nervous system can be detected by the laboratory. The use of nitrocellulose immunoblotting for the identification of antibodies which are specific to Treponema pallidum and Human Immunodeficiency Virus Type-1 are discussed.

Clinical significance of cerebrospinal fluid tests for neurosyphilis

From 1978 to 1987, 1,665 cerebrospinal fluid (CSF) fluorescent treponemal antibody absorption (CSF-FTA-ABS) tests were performed as the screening procedure for neurosyphilis. The CSF samples from 48 patients were reactive, and the medical history and results of the CSF-Venereal Disease Research Laboratory test (CSF-VDRL) for syphilis for 38 of these patients were reviewed. Likely active neurosyphilis was diagnosed if the patient had a reactive CSF-FTA-ABS test, recent onset of neurological signs consistent with neurosyphilis, abnormal CSF, and no other recognized cause for the neurological illness. Fifteen patients were so classified. Four had a reactive CSF-VDRL test. The specificity of the CSF-VDRL in diagnosing likely active neurosyphilis was 100%, but the sensitivity was only 27%. The insensitivity of the CSF-VDRL test limits its usefulness as a screening test for neurosyphilis. The CSF-FTA-ABS test appears more sensitive for screening but is less specific than the CSF-VDRL test in distinguishing currently active neurosyphilis from past syphilis. These findings imply that clinical judgment is still essential in establishing the diagnosis of active neurosyphilis.

Comparative evaluation of commercial fluorescent treponemal antibody-absorbed test kits

We describe a comparative evaluation of commercial fluorescent treponemal antibody-absorbed test kits, using 150 selected patient sera. The ability of the test kits to detect reactive sera varied from 82.5 to 95%; that for nonreactive sera varied from 80.9 to 96.4%. Reproducibility of reactive and nonreactive results, measured by between-assay and within-assay studies, averaged 42%. The results showed substantial variation in performance characteristics among the kits, with important clinical implications for the diagnosis of syphilis. We recommend the development of an immunological standard for use in the manufacture of fluorescent treponemal antibody-absorbed test kits, with the goal of obtaining uniform performance characteristics among commercial test kits.

Laboratory investigation of syphilis

Without treatment, syphilis passes through primary, secondary, latent, and tertiary stages. The disease can be diagnosed directly by microscopic identification of the infective organism or serologically. Nontreponemal serologic tests are most suitable for screening and following response to therapy, while treponemal tests are used to confirm a positive nontreponemal test result. Biologic false positives are not uncommon. Because of the danger of infection to the fetus, serologic testing for syphilis is mandatory in all pregnant women. Nontreponemal tests can also be performed on CSF to document neurosyphilis.

Cerebrospinal fluid findings in asymptomatic patients with reactive serum fluorescent treponemal antibody absorption tests

It is common to examine the cerebrospinal fluid in untreated or inadequately treated asymptomatic patients with a reactive serum fluorescent treponemal antibody absorption (FTA-ABS) test before initiating antibiotic therapy for syphilis. This prospective study evaluated the usefulness of such examination. Four hundred thirty-two patients over 40 years old, reporting for annual physical examination, had a serum FTA-ABS test. Thirty-seven (8.6%) patients and 2 of 4 spouses were reactive repeatedly. Of the 39 patients with reactive tests, 7 had a history of penicillin therapy for syphilis, 5 had received heavy metal therapy, and 27 had no history of syphilis. These 39 patients had a neurological examination, serum VDRL, Treponema pallidum immobilization (TPI), and repeat FTA-ABS tests by two other laboratories. The TPI test was reactive in 30 (77%). Four had nonspecific neurological signs. Routine CSF examination (cells, total protein, VDRL, glucose, IgG%) on 30 patients with a history of inadequate treatment had a low diagnostic yield. Two patients had an unexplained total protein elevation (57 and 61 mg/dl) and 1 had a mildly increased IgG% (15%). All cell counts, VDRL tests, and glucose levels were normal. Agarose electrophoresis demonstrated one or more CSF immunoglobulin bands in 10 (36%) of 28 patients, possibly representing an immunological marker of past or latent central nervous system infection.

Evaluation of a modified FTA-ABS test multispot FTA-ABS

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