Qualitative and quantitative aspects of the serological diagnosis of early syphilis

Scottish Bacterial Sexually Transmitted Infections Reference Laboratory, Laboratory Medicine (Microbiology), 51 Little France Crescent, Edinburgh, Scotland, UK.
International Journal of STD & AIDS (Impact Factor: 1.04). 10/2008; 19(9):620-4. DOI: 10.1258/ijsa.2008.008103
Source: PubMed

ABSTRACT The aim of the present study was to evaluate the use of various serological tests in the diagnosis of early syphilis. The Murex enzyme immunoassay (EIA) test was used for screening; the Venereal Diseases Research Laboratory (VDRL) test, the Treponema pallidum particle agglutination assay (TPPA) and the Mercia antitreponemal IgM EIA were used in all the patients with a positive screening test and in those with suspected syphilis or in known contacts. In 89 cases of primary syphilis, the Murex EIA screening test was positive in 67 (75%) patients, the Mercia IgM EIA in 80 (90%) cases, the VDRL in 60 (67%) cases and the TPPA in 85 (96%) cases. All the tests were positive in 68 patients with secondary syphilis. In 72 cases of early latent syphilis, the Murex EIA screening test was positive in 68 (94%) patients, the Mercia IgM EIA in 50 (69%) cases, the VDRL in 61 (85%) cases and the TPPA in 68 (94%) cases. The Mercia IgM EIA was the only test positive in four (6%) of these cases; these four patients were known contacts. Antibody titres in the VDRL and TPPA increased as the infection progressed.

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    ABSTRACT: Objective To identify the demographic characteristics, risk factors and motivations for donating among blood donors with reactive serologic tests for syphilis.Background Post-donation interviews with syphilis seropositive blood donors improve recruitment and screening strategies.Methods This case–control study compares 75 Venereal Disease Research Laboratory (VDRL) > 8, EIA+ (enzyme immunoassay) and FTA-ABS+ (fluorescent treponemal antibody); 80 VDRL−, EIA+ and FTA-ABS+; and 34 VDRL− and EIA− donors between 2004 and 2009. Donors were assessed by their demographic characteristics, sexual behaviour, history of alcohol and illicit drugs use, and motivations to donate.ResultsDonors with VDRL > 8 were more likely to be divorced [AOR = 12·53; 95% confidence interval (CI) 1·30–120·81], to have had more than six sexual partners (AOR=7·1; 95% CI 1·12–44·62) and to report male–male-sex in the past 12 months (AOR=8·18; 95% CI 1·78–37·60). Donors with VDRL−, EIA+ and FTA-ABS+ were less likely to be female (AOR=0·26; 95% CI 0·07–0·96), more likely to be older (AOR=10·2; 95% CI 2·45–42·58 ≥ 39 and <60 years old) and to have had more than six sexual partners in the past 12 months (AOR = 8·37; 95% CI 1·49–46·91). There was no significant difference among groups regarding illicit drugs use; 30·7% (VDRL > 8) and 12·5% (VDRL−, EIA+ and FTA-ABS+) of donors reported that they had been at risk for HIV infection (P = 0·004). One-third of donors came to the blood bank to help a friend or a relative who needed blood.Conclusion Although donors exposed to syphilis reported and recognised some high risk behaviour, most were motivated by direct appeal to donate blood. Monitoring the risk profile of blood donors can benefit public health and improve blood safety.
    Transfusion Medicine 04/2014; 24(3). DOI:10.1111/tme.12124 · 1.31 Impact Factor
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    ABSTRACT: Potential organ and tissue donors are tested to detect infection with T. pallidum, the etiologic agent of syphilis. Important considerations for testing potential donors include available specimen type and volume, turnaround time, and ability to distinguish between past and current infection. Aspects of syphilis infection that inform organ and tissue donor assay selection and interpretation and the principles underlying available assays are described. Serologic assays for syphilis are the methods most commonly used in donor testing. The two categories of serologic assays, treponemal and nontreponemal, have advantages and limitations for testing potential donors. Knowledge of the common syphilis-testing algorithms used in clinical diagnostic testing is useful for assay selection in the organ and tissue donor setting.
    Current Infectious Disease Reports 09/2014; 16(9):423. DOI:10.1007/s11908-014-0423-z
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    ABSTRACT: OBJECTIVES: IgM antibodies are usually the first to be produced during treponemal infection. Three commercially available enzyme immunoassays (EIA) for detection of IgM antibodies against Treponema pallidum were evaluated. METHODS: Results of the Anti-Treponema-pallidum-ELISA (IgM; Euroimmun), Pathozyme Syphilis-M Capture (Omega Diagnostics) and recomWell Treponema IgM (Mikrogen) were compared with those of the Treponema pallidum particle agglutination (TPPA) and the Venereal Disease Research Laboratory (VDRL) tests for 307 serum samples. RESULTS: The overall sensitivity (95% confidence interval [CI]) of the TPPA was 100% (97.7-100%) compared to 83.3% (76.5-88.8%) of the VDRL, 88.5% (82.4-93.0%) of the Pathozyme, 84.6% (78.0-89.9) of the Euroimmun, and 73.6% (66.1-80.4%) of a modified recomWell test procedure. Specificities were in the range of 91.4-100%. In primary syphilis, sensitivities of the Pathozyme (89.8%; 95% CI, 79.2-96.2%) and Euroimmun tests (81.4%; 95% CI, 69.1-90.3%) were significantly higher (p < 0.05) than the sensitivity of the VDRL test (61%; 95% CI, 47.4-73.5%). IgM EIAs even were positive in some cases of suspected very early infection where the VDRL was non-reactive and the TPPA was indeterminate. CONCLUSIONS: In cases of suspected early infection specific IgM EIAs should be used in addition to other screening tests. The VDRL is not recommended for screening.
    The Journal of infection 03/2013; DOI:10.1016/j.jinf.2013.03.011 · 4.02 Impact Factor


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