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Syphilis (Serology and Biological False Positive Phenomenon

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Syphilis (Serology and Biological False Positive Phenomenon Br J Vener Dis: first published as 10.1136/sti.53.5.328 on 1 October 1977. Downloaded from British Journal of Venereal Diseases, 1977, 53, 328-336 Abstracts These selected abstracts and titles from the world literature are arranged in the following sections: Syphilis and other treponematoses Trichomoniasis (Clinical and therapy; serology and biologicalfalse Candidosis positive phenomenon; pathology and experimental) Genital herpes Gonorrhoea Other sexually transmitted diseases (Clinical; microbiology; therapy) Public health and social aspects Non-specific genital infection Miscellaneous Reiter's disease The RST is thought to offer the ad- Syphilis and other Syphilis (Serology and biological vantage of a stable antigen which gives a treponematoses (Clinical and false positive phenomenon smooth background with negative sera therapy) compared with the slightly coarse back- Evaluation of reagin screen, a new ground with the particulate RPR antigen.copyright. A. E. Wilkinson Infectious syphilis mimicking neoplastic serological test for syphilis disease J. D. DYCKMAN, R. D. WENDE, [Reprinted from Abstracts on Hygiene, by of the L. M. DRUSIN, C. SINGER, A. J. VALENTI, D. GANTENBEIN, AND R. P. WILLIAMS (1976). permission Editor.] AND D. ARMSTRONG (1977). Journal of Clinical Microbiology, 4, 145-150 Archives ofInternal Medicine, 137, Fluorescent treponemal antibody 156-160 The reagin screen test (RST) is carried out absorption (FTA-ABS) tests using blood on unheated serum on cards with a samples collected on filter paper The case histories are given of five lipoidal antigen stained with a blue dye. D. R. HOPKINS (1977). patients with lesions at first thought to be Its performance is compared with the American Journal of Tropical Medicine http://sti.bmj.com/ neoplasms but which were later shown to VDRL, RPR card, and FTA-ABS tests. and Hygiene, 26, 188-189 be due to early syphilis. The first patient The sera tested were from 243 patients complained of persistent headache, and with untreated syphilis at various stages, Specimens of blood were collected by the presence of unilateral papilloedema 345 patients with treated syphilis, 257 venepuncture from 111 patients known to raised suspicions of an intracranial presumed normal persons, and 175 have, or suspected of having, syphilis. growth. Two patients had rectal lesions patients with various conditions which Two or three drops of blood were placed thought to be carcinomas, one an ulcer of may produce biological false positive on Whatman no. 3 filter paper to give a on October 2, 2021 by guest. Protected the tongue, and one enlarged cervical (BFP) reactions. These included 11 yaws circle 1 cm in diameter and allowed to lymph nodes and lesions of the nose and sera which do not really belong in this dry overnight. The blood was eluted in skin thought to be due to lymphoma. Four category. From the results it appears that 0-2 ml sorbent to give an approximately I of the patients had skin lesions of secon- the RST was rather less sensitive than the in 8 dilution of serum. FTA-ABS tests dary syphilis and one gave a history of VDRL or RPR test in the syphilitic sera, were carried out on this in parallel with these. Biopsies had been carried out on particularly those from treated patients. tests on inactivated serum at a dilution of three patients before positive serological In this group the RPR was reactive in 1 in 5 in sorbent. Sixty-two sera and 56 tests showed the correct diagnosis. 86%, the VDRL in 85 5%, and the RST eluates gave reactive tests. Qualitatively, Early infectious syphilis is still common in 78-8%. A comparison of quantitative fluorescence was brighter with the sera and there should be more general aware- tests showed that the RST tended to give than with the eluates, but the use of blood ness of its often diverse manifestations. slightly lower titres than the RPR or collected on paper from fingerpricks is Osler's dictum that syphilis simulates every VDRL. None of these three tests was thought to be practicable in the FTA-ABS other disease is still true today. reactive with the normal sera and the test, especially in field studies. A. E. Wilkinson specificity was about equal with the sera The difference in serum dilution favours [Reprinted from Abstracts on Hygiene, by from conditions associated with BFP the test on serum. The circles of absorbent permission of the Editor.] reactions. paper (rondelles) described by Guthe, 328 Br J Vener Dis: first published as 10.1136/sti.53.5.328 on 1 October 1977. Downloaded from Abstracts 329 1966 (Acta dermato-venereologica, 46, 72) get lower readings with syphilitic sera but in an atmosphere of 95 % N2 and 5 % CO2 which take up a reproducible volume of higher readings with some sera from or the addition of reducing agents blood would be more suitable for collect- patients judged not to have syphilis. The (glutathione, cysteine, sodium thioglycol- ing specimens by this method. proportion of borderline readings was late, dithiothreitol). Incubation beyond A. E. Wilkinson similar in the two laboratories and these 48 hours was detrimental to the survival [Reprinted from Abstracts on Hygiene, by did not correlate well with a diagnosis of of the cell monolayers. In an atmosphere of permission of the Editor.] syphilis. At the reference centre 71 of 76 1 part air and 6 parts of the N2-C02 patients with reactive FTA-ABS tests mixture, corresponding to 30% oxygen, were considered to have syphilis and five the cells were found to survive for between Borderline and reactive FTA-ABS results to have given false positive FTA-ABS two and three weeks. In tests under this in lupus erythematosus tests. At the local laboratory only 71 atmosphere normal rabbit serum or fetal R. N. SHORE AND J. A. FARICELLI (1977). (62-8 %) of 113 patients with reactive bovine serum promoted treponemal sur- Archives of Dermatology, 113, 37-4 FTA-ABS tests were thought to have vival better than preparations of bovine syphilis; the remainder were classed as serum albumen. Serological tests for syphilis were per- false positive reactions. Various cell lines were used; some of formed on sera from 43 patients with lupus The use of the FTA-ABS test as a these, mainly derived from animals other erythematosus. Four of the patients had screening procedure in a population with a than rabbits, produced local skin reactions clinical evidence of syphilis and a positive low prevalence of syphilis is thought in- when injected without treponemes. These result in the TPI test. Among the remain- advisable. Its use should be limited to non-specific lesions did not increase in ing 39, reactions which were probably non- patients with reactive VDRL tests and to size or ulcerate and could be distinguished syphilitic were seen as follows: reactive those suspected to have late syphilis. The from the infectious lesions caused by FTA-ABS tests (10 patients), positive use of the Treponema pallidum haemag- treponemes. One cell line, derived from VDRL (11 patients), positive rapid plasma glutination test as an initial confirmatory rabbit epidermis, appeared to promote reagin card tests (5 patients), positive test should be considered, keeping the survival of treponemes better than other microhaemagglutination Treponema palli- FTA-ABS test as an arbiter in problem lines. When these cells were incubated dunm assay tests (4 patients). It was noted cases. with treponemes in medium containing that seven of the 10 positive FTA-ABS [The FTA-ABS test is widely used; this glutathione and cysteine under an atmo- tests were of borderline reactivity and in report shows its limitations and the need sphere of 30% oxygen and dithiothreitol none was there a 'beaded' pattern of for caution in the interpretation of added at intervals, there was no apparentcopyright. fluorescence. The titres of the presumed results.] decrease in the number of virulent tre- non-syphilic positive microhaemagglutina- A. E. Wilkinson ponemes for up to six days. At this time, tion tests were < 1 in 320. [Reprinted from Abstracts on Hygiene, by lesions developed at all inoculated sites (Perhaps reactive FTA-ABS tests in permission of the Editor.] after a mean interval of 4-7 days. lupus erythematosus should be evaluated A. E. Wilkinson by the use of Reiter's sonicate rather than by the sorbents used by the authors. A further study on the specificity of the Syphilis (Pathology and Selective response of lymphocytes from microhaemagglutination assay test in Treponema pallidum-infected rabbits to http://sti.bmj.com/ lupus erythematosus may be needed.) Experimental) mitogens and Treponema reiteri D. J. M. Wright C. S. PAVIA, J. B. BASEMAN, AND J. D. Interaction if Treponema pallidum FOLDS (1977). Infection and Immunity, 15, (Nichols strain) with cultured mammalian 417-422 The FTA-ABS test: a diagnostic help or cells; effects of oxygen, reducing agents, hindrance? serum supplements and different cell types Rabbits were infected intratesticularly P. E. DANS, F. N. JUDSON, S. A. LARSEN, T. J. FITZGERALD, R. C. JOHNSON, J. A. with the virulent Nichols strain of AND M. A. LANTZ (1977). SYKES, AND J. N. MILLER (1977). Treponema palliduim. Animals infected on October 2, 2021 by guest. Protected Southern Medical Journal, 70, 312-315 Infection and Immunity, 15, 444-452 with treponemes killed by heating at 56°C for an hour provided a control group. This study was carried out on 1043 patients Virulent Nichols strain Treponema palli- Peripheral blood lymphocytes were col- attending a venereal disease clinic who dum was harvested from the testes of lected at weekly intervals for 12 weeks were suspected of having syphilis. FTA- infected rabbits into modified Eagle's after inoculation and cultured for 60 ABS and VDRL tests were carried out at minimal medium with various supple- hours at 37°C in the presence of phyto- the local laboratory and sera from 226 ments, and added to cell monolayers.
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