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Kesserwani H. Decomplexifying Serum and Cerebrospinal Fluid (CSF) Serologic Testing of Neurosyphilis: A Case Report of Ocular Syphilis and Highlights of the Principles of Serologic Testing. Cureus 2020; 12:e11533. [PMID: 33354477 PMCID: PMC7746323 DOI: 10.7759/cureus.11533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 11/30/2022] Open
Abstract
Serologic tests for syphilis can be quite complex. The screening and confirmatory tests, which number at least eight, are mathematically interpreted as a total of 16 possible combinations, if we choose one test from each of two sets of four. However, this bewildering complexity is simplified if we apply certain principles. We reiterate and propose four axioms. First, we distinguish between treponemal versus non-treponemal tests. The former, the treponemal test, is specific for the spirochete, treponema pallidum, and is used as a confirmatory test. It rarely declines over time. The latter, the non-treponemal test, is a screening test and reflects treponemal or tissue damage, is reported as a titer, and is used to monitor disease activity. We usually need both for screening and confirmatory diagnostic testing. Secondly, for rapid plasma reagin (RPR) tests, a non-treponemal serology test titer of at least 1:8 is suggestive of syphilis, but not necessarily neurosyphilis. A false-negative test usually registers below this dilution level and may be due to the "prozone phenomenon". Serum RPR titers are usually greater than 1:32. Thirdly, a negative treponemal test in the cerebrospinal fluid excludes neurosyphilis and a positive test is highly sensitive but lacks specificity, usually due to blood contamination. Most patients with neurosyphilis will have a positive non-treponemal test in the cerebrospinal fluid (CSF) with elevated protein and pleocytosis. Fourthly, a serological cure is defined as at least a four-fold decline in a non-treponemal test titer at three and six months, or a persistently low titer after treatment. Patients who do not fulfill these criteria are known as "serofast". We describe the case of a 38-year-old man with human immunodeficiency virus-type 1 who developed bilateral optic disc edema with photopsias and transient visual obscurations.
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Cardinal LJ. Diagnostic testing: a key component of high-value care. J Community Hosp Intern Med Perspect 2016; 6:31664. [PMID: 27406456 PMCID: PMC4942505 DOI: 10.3402/jchimp.v6.31664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/16/2016] [Accepted: 05/02/2016] [Indexed: 11/18/2022] Open
Abstract
This is the fourth article of a series on fundamental concepts in biostatistics and research. In this article, the author reviews the fundamental concepts in diagnostic testing, sensitivity, and specificity and how they relate to the concept of high-value care. The topics are discussed in common language, with a minimum of jargon and mathematics, and with clinical examples. Emphasis is given to conceptual understanding. A companion article will follow focusing on predictive value and prior probability.
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Affiliation(s)
- Lucien J Cardinal
- Internal Medicine Residency Program, Stony Brook Medicine at Mather Hospital, John T. Mather Memorial Hospital, Port Jefferson, NY, USA;
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Abstract
BACKGROUND Current U.S. policy requires screening of all deceased organ donors for syphilis infection. To date, information on syphilis test performance in this population is limited. METHODS All donors with a positive rapid plasma reagin (RPR) and matched donors with negative RPR who were evaluated by one organ procurement organization from January 1, 2000, to September 30, 2012, were retrospectively tested, using retained, residual serum, with two alternate RPR tests and four treponemal-specific tests: A fluorescent treponemal antibody absorption test, a microhemagglutination test, a chemiluminescence immunoassay (CLIA), and a Treponema pallidum particle agglutination (TP-PA) test. RESULTS Thirty-two of 3,555 (0.9%) potential deceased organ donors screened during the study period showed a positive RPR; 61 RPR-negative matched donor samples were studied as well. Thirteen (40.6%) of the RPR-positive donors were found to be false-positive based on confirmatory TP-PA. As compared to TP-PA, the sensitivity of the fluorescent treponemal antibody absorption, microhemagglutination, and CLIA was 87.5%, 91.7% and 100%, respectively. The CLIA and TP-PA results were 100% concordant. Only 17 (53.1%) of the RPR-positive donors had a total of 46 organs recovered for transplantation. CONCLUSION Current screening of deceased organ donors by RPR yields a significant number of false-positive results. Use of alternative tests or the routine use of confirmatory tests may reduce the frequency of false-positive results in deceased organ donors.
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Improved Reverse Screening Algorithm for Treponema pallidum Antibody Using Signal-to-Cutoff Ratios from Chemiluminescence Microparticle Immunoassay. Sex Transm Dis 2014; 41:29-34. [DOI: 10.1097/olq.0000000000000066] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Clark CA, Laskin CA, Spitzer KA. Anticardiolipin antibodies and recurrent early pregnancy loss: a century of equivocal evidence. Hum Reprod Update 2012; 18:474-84. [DOI: 10.1093/humupd/dms020] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Hwang HY, Kim MH. Practical Application of Quantitative HiSens Auto Rapid Plasma Reagin Latex Turbidimetric Immunoagglutination for Diagnosing Syphilis; Comparison Analysis between Rapid Plasma Reagin Latex Turbidimetric Immunoagglutination Test and Rapid Plasma Reagin Card Test. Infect Chemother 2009. [DOI: 10.3947/ic.2009.41.3.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hyun Yong Hwang
- Department of Laboratory Medicine, Kosin University College of Medicine, Busan, Korea
| | - Mi Hyang Kim
- Department of Laboratory Medicine, Kosin University College of Medicine, Busan, Korea
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Martin IE, Lau A, Sawatzky P, Tsang RSW, Cuff W, Lee C, Macpherson PA, Mazzulli T. Serological diagnosis of syphilis: enzyme-linked immunosorbent assay to measure antibodies to individual recombinant Treponema pallidum antigens. J Immunoassay Immunochem 2008; 29:143-51. [PMID: 18360809 DOI: 10.1080/15321810801887771] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We standardized an indirect ELISA for measurement of serum antibody levels to four individual treponemal recombinant proteins that have been commonly used in a number of commercial EIAs, mostly as a mixture of antigens. When tested with 127 syphilis-negative and 37 secondary syphilis sera, ELISA O.D.s obtained for each of the four antigens clearly distinguished between these two groups of samples. Sensitivity and specificity of 100% was obtained with the current set of samples. Further evaluations with sera from different stages of syphilis can help to define the applications of this ELISA test for each of the four antigens studied.
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Affiliation(s)
- Irene E Martin
- Pathogenic Neisseria and Syphilis Diagnostic Section, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
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Stone DL, Moheng MC, Rolih S, Sinor LT. Capture-S, a nontreponemal solid-phase erythrocyte adherence assay for serological detection of syphilis. J Clin Microbiol 1997; 35:217-22. [PMID: 8968911 PMCID: PMC229542 DOI: 10.1128/jcm.35.1.217-222.1997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A solid-phase erythrocyte adherence assay has been developed for the serological detection of reagin antibodies in syphilis. Capture-S (Immucor, Inc., Norcross, Ga.) is a nontreponemal, qualitative screening test for the detection of immunoglobulin G (IgG) and IgM antilipid antibodies in serum or plasma samples from blood donors. The Capture-S assay utilizes a modified Venereal Disease Research Laboratory antigen bound to microtitration wells and anti-IgG- plus anti-IgM-coated indicator erythrocytes as the detection system. The Capture-S assay was evaluated at six separate sites on 10,942 specimens. For patient samples of clinically diagnosed syphilis categories (n = 366), the Capture-S assay yielded a sensitivity of 80.7% versus 80.3% for the rapid plasma reagin (RPR) card test (Becton Dickinson Microbiology Systems, Cockeysville, Md.). In comparative experiments on patient and donor samples (n = 10,222), the Capture-S assay demonstrated a sensitivity of 94% compared to 91.2% for the RPR card test. The Capture-S and RPR card tests produced essentially equivalent specificities of 99.2% and 99.3%, respectively, for this sample population. For five test sites, the Capture-S and RPR card test demonstrated a 98.3% agreement (10,085 of 10,264) of test results. These evaluations indicate that the Capture-S compares favorably to the RPR card test in assay sensitivity and specificity, with the added benefits of ease of use, accommodation of high-volume testing, and potential for automation.
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Affiliation(s)
- D L Stone
- Immucor, Inc., Norcross, Georgia 30071, USA
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Zrein M, Maure I, Boursier F, Soufflet L. Recombinant antigen-based enzyme immunoassay for screening of Treponema pallidum antibodies in blood bank routine. J Clin Microbiol 1995; 33:525-7. [PMID: 7751351 PMCID: PMC227984 DOI: 10.1128/jcm.33.3.525-527.1995] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
This work reports a comparison of an enzyme immunoassay (EIA) using two major Treponema pallidum recombinant antigens with a T. pallidum hemagglutination (TPHA) assay and a nontreponemal Venereal Disease Reference Laboratory (VDRL) test. A total of 1,822 normal donor serum samples was tested for cardiolipin and T. pallidum antibodies, respectively, by the VDRL assay and EIA. Among these samples, 440 were further tested by TPHA technology. Four samples were found positive by EIA, while all were reported to be negative by both TPHA and VDRL routine assays. Subsequent testing of EIA-positive samples confirmed 100% (four of four samples) and 25% (one of four samples) positive results, respectively, by immunofluorescence assay and a Western blot (immunoblot) syphilis kit. The sensitivity of the recombinant EIA was estimated at virtually 100% with a reference panel of 50 syphilitic samples. According to this study, the newly developed EIA kit shows 100% sensitivity combined to a specificity greater than 99.8% for detecting treponemal immunoglobulin G antibodies in blood bank syphilis screening.
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Affiliation(s)
- M Zrein
- Diagast Laboratories, Lille, France
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Hooper NE, Malloy DC, Passen S. Evaluation of a Treponema pallidum enzyme immunoassay as a screening test for syphilis. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 1994; 1:477-81. [PMID: 8556488 PMCID: PMC368293 DOI: 10.1128/cdli.1.4.477-481.1994] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The CAPTIA Syphilis-G enzyme immunoassay for the detection of antibodies to Treponema pallidum was evaluated as a screening test for syphilis in comparison with the standard rapid plasma reagin (RPR) test. One thousand samples were tested, and the standard fluorescent treponemal antibody absorption test and the standard microhemmaglutination test were used to confirm the presence of treponemal antibodies. Diagnosis of syphilis was based on traditional standard serology results. Clinical data used in the diagnosis of patients whose samples yielded conflicting results were provided by physicians. Initially, 7 patients whose samples were reactive in the RPR test and 14 patients whose samples yielded positive or equivocal results in the CAPTIA Syphilis-G test were diagnosed as not being infected. After discrepancies due to technical problems were reconciled, samples from six patients remained reactive in the RPR test and that from one patient remained positive in the CAPTIA Syphilis-G test. In addition, seven patients whose samples were nonreactive in the RPR test and two patients whose samples were negative in the CAPTIA Syphilis-G test were diagnosed as having untreated syphilis. After discrepancies were reconciled, samples from five patients remained nonreactive in the RPR test and none remained negative in the CAPTIA Syphilis-G test. Final results indicate that the specificities are 99.4 and 99.9%, respectively. In addition to the improved sensitivity and specificity of the CAPTIA Syphilis-G screen, other potential benefits of this assay lead us to believe that this method could serve as a better screening tool than the RPR test.
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Affiliation(s)
- N E Hooper
- Maryland Medical Laboratory, Inc., Baltimore 21227, USA
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False-negative syphilis screening: the prozone phenomenon, nonimmune hydrops, and diagnosis of syphilis during pregnancy. Am J Obstet Gynecol 1990; 163:975-7. [PMID: 2403176 DOI: 10.1016/0002-9378(90)91107-n] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The prevalence of congenital syphilis is rapidly rising in several areas of the United States. Efforts to control the disease depend on the effectiveness of established screening strategies and treatment of infected pregnant women. False-negative test results hinder these efforts and leave the fetus at risk for acquiring congenital syphilis. Recently we encountered four cases of false-negative syphilis serologic results in women who gave birth to infants with congenital syphilis. The false-negative results were caused by the prozone phenomenon. The prozone phenomenon, seen during primary and secondary syphilis, occurs because a higher than optimal amount of antibody in the tested sera prevents the flocculation reaction typifying a positive result in reagin tests. Serum dilution is necessary to make the correct diagnosis. We recommend that for any pregnant woman with apparently negative syphilis serologic results in whom fetal compromise of unknown etiology exists, particularly nonimmune hydrops, nontreponemal testing should be repeated using serum dilutions to prevent a missed diagnosis of syphilis. We further recommend serum dilution as a routine procedure for all pregnant women in areas of high syphilis prevalence.
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Abstract
Luetic hearing loss, a relatively rare disorder, is significant because it is one of the few forms of progressive sensorineural hearing loss that may be reversed if diagnosed early and accurately and treated aggressively. With the increased incidence of systemic syphilis over the past few decades, the otolaryngologist can expect otosyphilis to appear more frequently. This report reviews the clinical presentation, histopathology, diagnostic workup, and current therapy for this disorder.
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Affiliation(s)
- G L Darmstadt
- Department of Surgery, University of California, San Diego 92103
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Guinness LF, Sibandze S, McGrath E, Cornelis AL. Influence of antenatal screening on perinatal mortality caused by syphilis in Swaziland. Genitourin Med 1988; 64:294-7. [PMID: 3203929 PMCID: PMC1194246 DOI: 10.1136/sti.64.5.294] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In a survey of 283 deliveries in Swaziland, active syphilis (positive results in the Treponema pallidum haemagglutination assay (TPHA) and the rapid plasma reagin (RPR) test) was found in 37 (13.1%) and possibly active infection (positive TPHA but negative RPR test results) in a further 87 (30.7%). The perinatal mortality of untreated mothers with active disease was 21.9% (7/32). The RPR test carried out antenatally by nurses had a sensitivity of 36% (13/36) and predictive accuracy of 48% (13/27). Awareness of this incidence of syphilis led to improved antenatal clinic measures and the prophylactic treatment of all newborn infants. More comprehensive serology is discussed and the prophylactic treatment of mothers considered. The need for health education aiming at safer sexual practices is of paramount importance in a society facing the arrival of the human immunodeficiency virus.
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Affiliation(s)
- L F Guinness
- Department of Obstetrics and Gynaecology, Mbabane Government Hospital, Swaziland
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Abstract
Otologic syphilis (luetic inner ear disease) usually is diagnosed by positive serologic tests and by exclusion of other possible causes. Because the FTA-ABS for syphilis is exquisitely sensitive in all but early primary cases, a positive FTA-ABS result and coincident inner ear disease often are thought to be diagnostic of syphilitic inner ear disease. The result is a management dilemma: are there false-positive results in misdiagnosed cases? Over 4 years, the authors performed a prospective study with time-matched controls to determine the predictive value of serologic tests and prevalence of syphilis in otology. Thirty-one cases of otologic syphilis were diagnosed in 5,439 new (different) patients with otologic complaints. In the geographic area studied, this prevalence (570/100,000) was 25-fold greater than that of all reported cases of syphilis in the general population (22.7/100,000). The defined sensitivity of the FTA-ABS (100%) was nearly twofold greater than the measured sensitivity of the rapid plasma reagin (RPR, 55%) in otologic syphilis. Specificities were comparable; therefore, a positive FTA-ABS had higher predictive value than a positive RPR. The prevalence-related predictive value of a positive FTA-ABS (22%) was more than twice that of the RPR (9%) in otology. The predictive value of a positive FTA-ABS in otology was 11-fold greater than that of the FTA-ABS in the general population (2%). Therefore, in suspect cases the FTA-ABS should be used to screen for otologic syphilis in an otologic practice. At a prevalence of 570 cases in 100,000 patients, only 22% of otologic patients with positive FTA-ABS results actually have otologic syphilis. Because disease morbidity can be far worse than treatment morbidity, however, positive results should be considered true-positives to avoid misdiagnosis in potentially infected patients. In suspect cases with positive FTA-ABS, therefore, treatment should be recommended unless specific contraindications exist.
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Stevens RW, Schmitt ME. Evaluation of an enzyme-linked immunosorbent assay for treponemal antibody. J Clin Microbiol 1985; 21:399-402. [PMID: 3884657 PMCID: PMC271673 DOI: 10.1128/jcm.21.3.399-402.1985] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
A new enzyme-linked immunosorbent assay with Treponema pallidum antigen bound to ferrous metal beads (Syphilis Bio-EnzaBead; Litton Bionetics Laboratory Products) was compared with the standard fluorescent treponemal antibody-absorption test for syphilis. Bio-EnzaBead and fluorescent treponemal antibody-absorption tests were done on 218 specimens from documented cases of syphilis, on 315 sera from individuals with diseases other than syphilis, and on sera submitted to a public health laboratory for premarital (304 specimens) or diagnostic (501 specimens) tests for syphilis. Agreement between the Bio-EnzaBead and reference tests ranged from 93.0% for sera for the diagnostic test to 99.5% for sera from patients with syphilis. The overall agreement among the 1,338 sera tested was 96.3%. The reproducibility of the Bio-EnzaBead test with 60 coded sera of graded reactivity was 97%. The test is easy to perform, the indicator results are clear and unequivocal, and the findings are comparable to those of the fluorescent treponemal antibody-absorption test.
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Moyer NP, Hudson JD, Hausler WJ. Evaluation of the hemagglutination treponemal test for syphilis. J Clin Microbiol 1984; 19:849-52. [PMID: 6381525 PMCID: PMC271197 DOI: 10.1128/jcm.19.6.849-852.1984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The sensitivity and specificity of the hemagglutination treponemal test for syphilis (HATTS) was compared with the fluorescent treponemal antibody-absorption test (FTA-ABS) with 491 sera. Medical histories were obtained for 153 patients with seroreactivity in either treponemal test. Overall correlation with patient history was 96.7% for the FTA-ABS and 93.9% for the HATTS. False-negative HATTS occurred in primary, late-latent (greater than 2 years), and treated syphilis. The reproducibility of the HATTS and FTA-ABS is equivalent. HATTS is an acceptable treponemal confirmatory test for syphilis, but the FTA-ABS should be used to resolve diagnostic discrepancies.
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Friedly G, Zartarian MV, Wood JC, Floyd CM, Peterson EM, de la Maza LM. Hemagglutination treponemal test for syphilis. J Clin Microbiol 1983; 18:775-8. [PMID: 6415097 PMCID: PMC270904 DOI: 10.1128/jcm.18.4.775-778.1983] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Sera from 290 hospital patients were tested to compare the sensitivity, specificity, and reproducibility of the hemagglutination treponemal test for syphilis (HATTS) with the fluorescent treponemal antibody absorption test (FTA-ABS). Complete agreement was obtained between the methods when 142 syphilitic sera from patients with various stages of syphilis were tested. By using clinical histories, the specificity with 148 nonsyphilitic sera was determined to be 100% for the HATTS and 96.6% (143 of 148) for the FTA-ABS. Satisfactory reproducibility was obtained with both methods. Compared with the FTA-ABS, the HATTS was more specific, easier, and more economical to perform. We therefore recommend the HATTS as a suitable alternative to the FTA-ABS.
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Pedersen NS, Petersen CS, Vejtorp M, Axelsen NH. Serodiagnosis of syphilis by an enzyme-linked immunosorbent assay for IgG antibodies against the Reiter treponeme flagellum. Scand J Immunol 1982; 15:341-8. [PMID: 7048509 DOI: 10.1111/j.1365-3083.1982.tb00657.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
An enzyme-linked immunosorbent assay for IgG antibodies against the flagellum (axial filament) of the Reiter treponeme (flagellum-ELISA) was developed and compared with the fluorescent treponemal antibody absorption (FTA-ABS) test and the Treponema pallidum immobilization (TPI) test with regard to diagnostic sensitivity and specificity. One serum from each of 827 individuals with and without syphilis was studied. In all diagnostic groups of syphilis there was no significant difference between the sensitivity of the FTA-ABS and the flagellum-ELISA, except in treated syphilis, where the FTA-ABS was more sensitive (P less than 0.01). In primary syphilis and in treated syphilis the sensitivity of the flagellum-ELISA was higher than the sensitivity of TPI (P less than 0.01 and P less than or equal to 0.05), respectively); in all other groups there was no significant difference between the sensitivity of TPI and flagellum-ELISA. The specificity of the flagellum-ELISA (99.0%) in 200 sera from blood donors without syphilis was not statistically different from the specificity of FTA-ABS (98.0%) and TPI (99.5%). The flagellum-ELISA seems to be well suited for routine serodiagnosis of syphilis and may replace other treponemal tests.
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Hambie EA, Larsen SA, Perryman MW, Pettit DE, Feeley JC. Heated versus unheated sera in the hemagglutination treponemal test for syphilis. J Clin Microbiol 1982; 15:337-8. [PMID: 7068830 PMCID: PMC272089 DOI: 10.1128/jcm.15.2.337-338.1982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Sera (920) were tested to evaluate the use of heated versus unheated sera in the hemagglutination treponemal test for syphilis. The heated and unheated samples were tested on the same day with the hemagglutination treponemal test for syphilis kit according to the manufacturer's protocol. Agreement of results between the heated and unheated sera was 99.2%. The reading pattern of agglutination was clearer and more distinct with heated sera; therefore, based solely on our preference for the reading patterns, we suggest that heated sera be used in the hemagglutination treponemal test for syphilis.
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Stevens RW, Schell RF. Solid-phase fluoroimmunoassay for treponemal antibody. J Clin Microbiol 1982; 15:191-5. [PMID: 7040442 PMCID: PMC272057 DOI: 10.1128/jcm.15.2.191-195.1982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
An objective, solid-phase fluoroimmunoassay for treponemal antibody was developed with a lysate of virulent Treponema pallidum (Nichols strain) adsorbed on cellulose acetate disks. A probe containing both the antigen and control disks is inserted successively into a serum specimen dilution, a buffer rinse, fluoroscein isothiocyanate-conjugated goat anti-human immunoglobulin G, and a second buffer rinse. Fluorescence signal units are measured with a fluorometer. To establish test calibration curves, the corrected fluorescence values (antigen disk minus control) of reference sera are plotted against indirect fluorescent treponemal antibody test titers. The corrected fluorescence values obtained for 62 sera reactive in the fluorescent treponemal antibody absorption test ranged from 64 to 178; values for 66 nonreactive sera ranged from 20 to 46. Thus, the solid-phase fluoroimmunoassay for treponemal antibody clearly separated specimens from patients with documented primary, secondary, or latent disease from fluorescent treponemal antibody absorption-nonreactive sera. The test is technically simple and produces an objective quantitative result.
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Larsen SA, Hambie EA, Pettit DE, Perryman MW, Kraus SJ. Specificity, sensitivity, and reproducibility among the fluorescent treponemal antibody-absorption test, the microhemagglutination assay for Treponema pallidum antibodies, and the hemagglutination treponemal test for syphilis. J Clin Microbiol 1981; 14:441-5. [PMID: 7026610 PMCID: PMC271999 DOI: 10.1128/jcm.14.4.441-445.1981] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Using 920 sera, we compared the specificity and reproducibility of the hemagglutination treponemal test for syphilis with those of the fluorescent treponemal antibody-absorption test and the microhemagglutination assay for Treponema pallidum antibodies; we found all three tests to be comparable. However, the hemagglutination treponemal test for syphilis, like the microhemagglutination assay for T. pallidum antibodies, lacked sensitivity in sera from patients with primary syphilis.
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Ursi JP, van Dyck E, van Houtte C, Piot P, Colaert J, Dlamini M, Meheus A. Syphilis in Swaziland: a serological survey. Br J Vener Dis 1981; 57:95-9. [PMID: 7214126 PMCID: PMC1045882 DOI: 10.1136/sti.57.2.95] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Sera from 536 adults and children in Swaziland were examined for their reactivity in the rapid plasma reagin (RPR) and Treponema pallidum haemagglutination (TPHA) tests. None of 130 sera from children was reactive in either test; 8.6% of sera from 185 healthy adults were reactive in the RPR test and 33% in the TPHA test; 24.5% of 220 sera from patients with genital ulcers were RPR-positive and 45.9% TPHA-positive. The RPR positivity rates were not related to age, but the percentage of RPR-negative, TPHA-positive sera increased with age in both the healthy adults and the patients with genital ulcers. Thus venereal syphilis appears to be responsible for these high positivity rates. Estimates of the yearly incidence of syphilis are identical for both groups--approximately 1.4%, an unusually high figure.
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