DOCSLIB.ORG

The Trouble with Treponemes

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Trouble with Treponemes Common Errors in Internal Medicine The Trouble with Treponemes Susan George, MD, CPT, MC, USA and Emil Lesho, DO, LTC, MC, USA Asking about a patient’s sexual history can mean the difference between a long, costly evaluation and a quick diagnosis when syphilis may be the etiology of the patient’s symptoms. 43-year-old, black man with lymphocytosis. Bone marrow biopsy not assume that a patient participates a history of hepatitis B pres- shows no sign of malignancy. in heterosexual activity exclusively. ents to a primary care clinic Based on these findings, his phy- Men who have sex with men have A with an enlarged lymph sicians explore infectious etiologies. an increased risk of infection with a node in his left groin. He reports that They order an HIV antibody test and quinolone resistant STD. The practi- this swollen lymph node has been Lyme disease, Epstein-Barr virus, and tioner in this case did appropriately present for several weeks. He says he cytomegalovirus titers—all of which discuss constitutional symptoms such has had no fever, chills, weight loss, are negative. as rash, fever, and weight loss, all rash, penile lesions or discharge, or The patient is referred to the infec- of which can be associated with previous episodes of a swollen lymph tious disease clinic. Toxoplasmosis infectious etiologies as well as with node in the groin area. He does not titers conducted there come back neg- malignancy. use tobacco or alcohol and has not ative. A rapid plasma reagin (RPR) Any patient with a history of a po- been taking any medications. test, however, is reactive at 1:64, and tential STD—hepatitis B in this pa- Physical examination reveals a this result is confirmed by a reactive tient’s case—should be screened for soft, 1- to 2-cm, nontender lymph- fluorescent treponemal antibody. other STDs, such as syphilis and HIV. adenopathy in the left groin without After treatment with a total of 7.2 This screening is particularly impor- overlying skin changes. No genital million U of benzathine penicillin IM tant with the increasing frequency of lesions are apparent. Results of the for late latent syphilis, the patient’s HIV and syphilis coinfection.1 In this patient’s complete blood count and RPR titer decreases fourfold and his case, completing a more thorough serum chemistries are normal. His lymphadenopathy resolves. history and STD investigation could provider prescribes levofloxacin PO have avoided a prolonged, expensive, 500 mg/day for suspected reactive CAN YOU IDENTIFY THE and invasive workup. lymphadenopathy. ERRORS? When, after one month, his lymph- The error in this case was the provid- GETTING TO THE ROOT OF THE adenopathy fails to resolve, he is given er’s failure to address the patient’s PROBLEM another two-week course of levoflox- sexual history and then consider sex- Syphilis has long been known as “the acin and is referred to an oncologist ually transmitted diseases (STDs) in great imitator” because of its protean for evaluation of possible lymphoma. the differential diagnosis of inguinal manifestations and diagnostic dilem- Computed tomography and positron lymphadenopathy. mas. It is an STD caused by infection emission tomography scans show cer- Obtaining a sexual history entails with the spirochete Treponema pal- vical, axillary, hilar, abdominal, pel- a discussion of how many sexual lidum, which often passes through vic, and inguinal lymphadenopathy. partners the patient has had, current three overlapping clinical stages. Lymph node biopsy reveals reactive sexual activity, condom use, and any history of genital ulcer disease. If the Primary syphilis CPT George is an infectious diseases fellow at patient reports previous ulcer disease, Patients with primary syphilis typi- Brooke Army Medical Center, San Antonio, TX. the provider should ask about the na- cally present with a chancre (a pain- LTC Lesho is an investigator in the division of ture of the disease, including whether less, small, round ulcer located at retrovirology at the Walter Reed Army Medical Center, Washington, DC and the National Navy the lesions were painful or recur- the site of infection) an average of 21 Medical Center, Bethesda, MD. rent. In addition, providers should days after exposure (range, 10 to 90 AUGUST 2006 • FEDERAL PRACTITIONER • 29 COMMON ERRORS IN INTERNAL MEDICINE days). This stage is often associated or condyloma lata, can be scraped GOOD NEWS IN TREATMENT with inguinal lymphadenopathy. and examined under a dark-field Fortunately, syphilis has not yet dem- microscope. This test is particularly onstrated any clinically significant Secondary syphilis important for patients with primary resistance to penicillin—its thera- Symptoms of secondary syphilis typi- syphilis, in whom an antibody re- peutic mainstay3 and drug of choice cally develop four to 10 weeks after sponse may not yet be positive. The for treatment. Primary, secondary, or the initial chancre. A rash occurs spirochete has a classic corkscrew early latent syphilis can be treated most often during this stage, usually or folding motion that is detectable with benzathine penicillin G 2.4 mil- described as macular or maculopapu- using this method of examination— lion U IM in a one-time dose. Patients lar. This rash commonly is found on provided the slides are examined with late latent syphilis, syphilis of the patient’s trunk, arms, palms of the immediately. In addition, the exam- unknown duration, or tertiary syphi- hands, or soles of the feet—but also ination’s sensitivity varies with the lis should be treated with benzathine may affect the face. The papules of skill of the technician. penicillin G 2.4 million U IM each secondary syphilis can coalesce in in- Scrapings should be examined on week for three weeks.5 Neurosyphi- tertriginous areas, causing highly in- three different days before a lesion is lis should be treated with benzathine fectious lesions known as condyloma determined to be free of T. pallidum.2 penicillin 3 to 4 million U IV every lata. The lesions may be accompanied Direct fluorescent antibody assays, four hours or as a continuous infu- by constitutional symptoms, such as such as the fluorescent treponemal an- sion for 10 to 14 days.5 low-grade fever, arthralgias, and gen- tibody-absorbed (FTA-abs) test, can Second-line agents, such as doxy- eralized lymphadenopathy. be used to detect treponemal antigens cycline, can be used in penicillin- Another manifestation of second- from scrapings. These tests are advan- allergic patients who are not pregnant ary syphilis is the appearance of su- tageous because they can be performed and do not have neurosyphilis. Peni- perficial, painless, mucosal erosions on dried specimens and, therefore, do cillin-allergic patients who are preg- in the mouth or genital regions. Cen- not require immediate evaluation by a nant or have neurosyphilis, however, tral nervous system (CNS) involve- specially trained microscopist. should undergo penicillin desensiti- ment during this stage can manifest Patients suspected of having syph- zation.5 as aseptic meningitis, cranial neurop- ilis are evaluated initially with a non- Follow-up with a nontreponemal athy, or anterior uveitis. treponemal serology test, such as RPR serology test (such as RPR) at six or venereal disease research labora- months and 12 months is recom- Latent syphilis tory tests, both of which measure an- mended. Treatment failure is defined Latent syphilis is defined as the pe- tibody response to lipoidal antigen. as either the failure of titers to decline riod after the manifestations of sec- Positive nontreponemal tests are fourfold within six months or a four- ondary syphilis resolve. Patients confirmed with a treponemal test, fold increase in titers after treatment become asymptomatic at this time, such as the FTA-abs, that measures is completed.5 which can be divided further into treponemal-specific antibodies by The RPR may not be available early and late stages. immunofluorescence. False-positive as a primary diagnostic modality in About one third of individuals nontreponemal results may be seen some settings with limited resources, with untreated latent syphilis de- with various conditions, including where targeted test-and-treat eradi- velop tertiary syphilis, characterized autoimmune diseases, tuberculosis, cation strategies are performed, be- by gumma—which are inflamma- pregnancy, infectious mononucleosis, cause cold storage is required for tory lesions of the skin, the CNS, or HIV, rickettsial infections, and other reagents and electricity is needed to bone. General pareses from cerebral spirochete infections (such as lepto- operate a rotator. To alleviate these involvement and tabes dorsalis from spirosis).3 Nontreponemal serology drawbacks, new RPRs that are stable posterior column demyelination tests are 78% to 86% sensitive during at room temperature are becoming characterize CNS involvement in ter- the primary syphilis stage, 100% sen- more readily available, as are solar tiary syphilis. sitive in secondary syphilis, and 95% powered rotators.6 to 98% sensitive in latent syphilis.4 Similarly, confirmatory assays usu- Diagnosis FTA-abs is 84% sensitive in primary ally are not available outside of ref- To make a syphilis diagnosis, muco- syphilis and 100% sensitive in sec- erence laboratories in these limited cutaneous lesions, such as chancre ondary and latent syphilis.4 settings, but the availability of confir- Continued on page 34 30 • FEDERAL PRACTITIONER • AUGUST 2006 NOTES FROM THE FIELD ing, and rescue services for the flight MWSS 372 corpsmen built cabinets formulary”—that usually are handled line and served as first responders to for field sinks, which have tanks of by support staff stateside. This tour any aviation mishaps. Corpsmen ac- water that are pumped to faucets and helped me to grow as a physician and companied each convoy and response drain into other containers. Other improve my diagnostic skills without team that left the base in case any in- projects—such as the remodeling of the benefit of many technological juries or illnesses occurred during the living areas and routing of cables for tools available at home.
Load more

Recommended publications
  • Section 13. Laboratory Considerations
    Section 13. Laboratory Considerations Table of Contents 13.1 Overview and General Guidance 13.2 Specimen Labeling 13.3 Procedures for Specimens That Cannot be Evaluated 13.4 Use of LDMS 13.5 Documentation 13.6 Urine Testing 13.6.1 Specimen Collection 13.6.2 Pregnancy Testing 13.6.3 Chlamydia and Gonorrhea Testing 13.6.4 Urine Culture 13.7 Blood Testing 13.7.1 Specimen Collection and Initial Processing 13.7.2 HIV Testing 13.7.3 Syphilis Testing 13.7.4 Hematology Testing 13.7.5 Serum Chemistries 13.7.6 Plasma Storage 13.7.7 CD4+ T Cell Count 13.7.8 HIV RNA PCR 13.7.9 HIV DNA PCR 13.8 Testing of Vaginal and Cervical Specimens 13.8.1 Vaginal pH 13.8.2 Wet Mount for Candidiasis and BV 13.8.3 Rapid Test for Trichomoniasis 13.8.4 Vaginal Gram Stain 13.8.5 Papanicolaou (Pap) Test 13.8.6 Self-Administered Vaginal Swabs for PK and biomarker testing 13.8.7 Endocervical Swabs for Biomarker Analysis 13.8.8 Intra-Vaginal Ring Storage 13.8.9 Herpes Lesion Testing Table 13-1 Volume Guide for Plasma Storage Appendix 13-1 Overview of Laboratory Testing Locations, Specimens, and Methods for MTN-020 Appendix 13-2 MTN-020 Lab Specimen Processing Guidelines Appendix 13-3 LDMS Specimen Management Guide to Logging in MTN-020 Specimens Appendix 13-4 MTN-020 HIV Testing Algorithms Appendix 13-5 MTN Network Lab HIV Query Form Appendix 13-6 LDMS Tracking Sheets This section contains information on the laboratory procedures performed in MTN-020.
    [Show full text]
  • Use of the Diagnostic Bacteriology Laboratory: a Practical Review for the Clinician
    148 Postgrad Med J 2001;77:148–156 REVIEWS Postgrad Med J: first published as 10.1136/pmj.77.905.148 on 1 March 2001. Downloaded from Use of the diagnostic bacteriology laboratory: a practical review for the clinician W J Steinbach, A K Shetty Lucile Salter Packard Children’s Hospital at EVective utilisation and understanding of the Stanford, Stanford Box 1: Gram stain technique University School of clinical bacteriology laboratory can greatly aid Medicine, 725 Welch in the diagnosis of infectious diseases. Al- (1) Air dry specimen and fix with Road, Palo Alto, though described more than a century ago, the methanol or heat. California, USA 94304, Gram stain remains the most frequently used (2) Add crystal violet stain. USA rapid diagnostic test, and in conjunction with W J Steinbach various biochemical tests is the cornerstone of (3) Rinse with water to wash unbound A K Shetty the clinical laboratory. First described by Dan- dye, add mordant (for example, iodine: 12 potassium iodide). Correspondence to: ish pathologist Christian Gram in 1884 and Dr Steinbach later slightly modified, the Gram stain easily (4) After waiting 30–60 seconds, rinse with [email protected] divides bacteria into two groups, Gram positive water. Submitted 27 March 2000 and Gram negative, on the basis of their cell (5) Add decolorising solvent (ethanol or Accepted 5 June 2000 wall and cell membrane permeability to acetone) to remove unbound dye. Growth on artificial medium Obligate intracellular (6) Counterstain with safranin. Chlamydia Legionella Gram positive bacteria stain blue Coxiella Ehrlichia Rickettsia (retained crystal violet).
    [Show full text]
  • Syphilis Diagnosis: Three Cases with Increasing Treponemal Test Result After Therapy
    Acta Derm Venereol 2014; 94: 323–324 SHORT COMMUNICATION Syphilis Diagnosis: Three Cases with Increasing Treponemal Test Result after Therapy Henrik O. Larsson1*, Annika Johnsson2 and Anders Bredberg1 Departments of 1Medical Microbiology, and 2Dermatology and Venereology, Skane University Hospital, Lund University, Jan Waldenströms gata 59, SE- 205 02 Malmö, Sweden. *E-mail: [email protected] Accepted May 4, 2013 Epub ahead of print Oct 3, 2013 Serology is a main tool for syphilis diagnostic work used (the Captia Syphilis-Enzywell Treponema IgG and IgM, (1–3). According to a recent survey performed by the respectively, EIA from Diesse, Monteriggioni, Italy); the IgG method uses antigen-coated wells and IgM is determined by U.S. Centers for Disease Control and Prevention (CDC) capture technique; a value over 1.0 is considered to be reactive 56% of infectious disease specialists responded that they (7). Particle agglutination was done at serum dilution 80 with send a rapid plasma reagin (RPR) test to the laboratory no quantitation of the result (TPPA, Fujirebio, Tokyo, Japan). and treat presumptively for syphilis (if result is negative 18% repeat the RPR testing before treating the patient, and 17% treat only if RPR is positive) (4). However, a RESULTS clearly positive reaction may be missing at the first visit Case 1 was tested twice, at 6 days before and 112 of patients with active syphilis (5). Non-treponemal test days after treatment start (Fig. 1, upper panel). The (e.g. RPR and Venereal Disease Research Laboratory treponemal screening value is rising from 4 to a highly (VDRL)) reactivity is known to decrease in response to reactive value of 14, while the non-treponemal VDRL therapy, in contrast to the typically life-long persistence titre decreases from a weak 1 to negativity.
    [Show full text]
  • Medical Bacteriology
    LECTURE NOTES Degree and Diploma Programs For Environmental Health Students Medical Bacteriology Abilo Tadesse, Meseret Alem University of Gondar In collaboration with the Ethiopia Public Health Training Initiative, The Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education September 2006 Funded under USAID Cooperative Agreement No. 663-A-00-00-0358-00. Produced in collaboration with the Ethiopia Public Health Training Initiative, The Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education. Important Guidelines for Printing and Photocopying Limited permission is granted free of charge to print or photocopy all pages of this publication for educational, not-for-profit use by health care workers, students or faculty. All copies must retain all author credits and copyright notices included in the original document. Under no circumstances is it permissible to sell or distribute on a commercial basis, or to claim authorship of, copies of material reproduced from this publication. ©2006 by Abilo Tadesse, Meseret Alem All rights reserved. Except as expressly provided above, no part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission of the author or authors. This material is intended for educational use only by practicing health care workers or students and faculty in a health care field. PREFACE Text book on Medical Bacteriology for Medical Laboratory Technology students are not available as need, so this lecture note will alleviate the acute shortage of text books and reference materials on medical bacteriology.
    [Show full text]
  • Rapid Syphilis Testing Protocol Wisconsin Department of Health Services STD Control Program
    Rapid Syphilis Testing Protocol Wisconsin Department of Health Services STD Control Program P-01832 June 2017 Table of Contents Bureau of Communicable Diseases (BCD) Staff Contact List ........................................................................ 3 Common Acronyms and Terms ..................................................................................................................... 4 Introduction and Background ....................................................................................................................... 5 Syphilis FAQ ................................................................................................................................................... 6 Rapid Syphilis Testing Algorithm ................................................................................................................... 9 Program Requirements ............................................................................................................................... 10 Agency Flow of Services .............................................................................................................................. 15 Rapid Syphilis Testing in Nontraditional or Outreach Settings ................................................................... 15 Syphilis Risk Assessment with Rapid Tests ................................................................................................. 17 Syphilis Health Check Testing Kit ...............................................................................................................
    [Show full text]
  • Evaluation of a Highly Sensitive Method of Measuring Syphilis TP Antibody, and a New Approach to Syphilis Testing
    Sysmex Journal International Vol. 22 No. 1 Evaluation of a Highly Sensitive Method of Measuring Syphilis TP Antibody, and a New Approach to Syphilis Testing Hiroshi SHIBATA, Hidehiko MORIYAMA, Yuki TANIGUCHI, Chikafumi MATSUDA and Atsushi NAGAI Central Clinical Laboratory, Shimane University Hospital 89-1 Enya, Izumo, Shimane, 693-8501 Japan. INTRODUCTION facilitates reaction between the sample (TP-Ab) and a biotinylated TP-Ag. In the next step, there is binding with Syphilis is a typical systemic sexually transmitted disease streptavidin-coated magnetic particles. Then, after that is caused by infection by Treponema pallidum (TP), bound/free (B/F) separation, the complex is further a pathogenic spirochete. Immunoserological tests with bound to ALP-labeled TP-Ag. After another B/F serum samples are generally used for testing TP separation, the chemiluminescent substrate CDP-Star is infection. These are typically TP antibody (TP-Ab) added and the intensity of luminescence measured. assays wherein a TP bacterial component is used as the We used VIRATROL (Sysmex) for examining the antigen, and serological test for syphilis (STS) that uses accuracy of the measurement, and an enzyme linked the phospholipid cardiolipin as the antigen. immunosorbent assay using TPauto·FS (KW) (ELSIA- In recent years, along with the advancement of testing TP; Sysmex) as the control for comparing the test results. methods, syphilis TP-Ab testing has been automated and Samples with disagreement of findings were investigated there have been considerable advances in improving through testing by TP hemagglutination assay (TPHA) sensitivity, speed and labor savings. We shall report here (Fujirebio Inc.), rapid plasma reagin (RPR) carbon the results of basic investigations on TP-Ab antigen test (Dainippon Sumitomo Pharma), and measurements using a recombinant TP antigen (TP-Ag) fluorescent Treponema antibody absorption test (FTA- and the automated immunoassay system HISCL-2000i ABS) (Nihon BCG Supply).
    [Show full text]
  • FTA-ABS Double Stain (Syphilis) IFA Kit
    DIAGNOSTIC AUTOMATION, INC. 23961 Craftsman Road, Suite D/E/F, Calabasas, CA 91302 Tel: (818) 591-3030 Fax: (818) 591-8383 [email protected] [email protected] www.rapidtest.com See external label 2°C-8°C Σ=10 x 10 tests Cat # 351010-DS FTA-ABS Double Stain (Syphilis) IFA Kit Cat # 351010-DS INTEDED USE The Diagnostic Automation, Inc. FTA-ABS Double Stain test system is designed to confirm positive non-treponemal reagin tests for syphilis and is for in vitro diagnostic use. This product is not FDA cleared (approved) for use in testing (i.e., screening) blood or plasma donors. SIGNIFICANCE AND BACKGROUND Serological procedures for syphilis are currently divided into two general groups of tests: 1. The non-treponemal antigen reagent screen tests, of which the Venereal Disease Research (VDRL) and Rapid Plasma Reagin Card (RPR) procedures are the most frequently employed. 2. The treponemal antigen tests, of which the Fluorescent Treponemal Antibody-Absorption (FTA- ABS), and more recently, the Fluorescent Treponemal Antibody-Absorption Double Stain (FTA- ABS-DS) test are the most commonly employed confirmatory test procedures (1-9). Although the nontreponemal tests such as the VDRL procedure provide a relatively simple and reliable means to screen syphilis patients, they also produce a significant number of biologically false positive DAI Code # 2 1 (BFP) reactions. These reactions are defined as patients whose sera give a positive VDRL reaction (usually weakly reactive or titer less than 1:8), a negative FTA-ABS and no history or physically findings to suggest syphilis (10-11). Consequently, a VDRL positive screen should be confirmed with a more specific test for syphilis such as the FTA-ABS procedure.
    [Show full text]
  • Laboratory Diagnosis of Sexually Transmitted Infections, Including Human Immunodeficiency Virus
    Laboratory diagnosis of sexually transmitted infections, including human immunodeficiency virus human immunodeficiency including Laboratory transmitted infections, diagnosis of sexually Laboratory diagnosis of sexually transmitted infections, including human immunodeficiency virus Editor-in-Chief Magnus Unemo Editors Ronald Ballard, Catherine Ison, David Lewis, Francis Ndowa, Rosanna Peeling For more information, please contact: Department of Reproductive Health and Research World Health Organization Avenue Appia 20, CH-1211 Geneva 27, Switzerland ISBN 978 92 4 150584 0 Fax: +41 22 791 4171 E-mail: [email protected] www.who.int/reproductivehealth 7892419 505840 WHO_STI-HIV_lab_manual_cover_final_spread_revised.indd 1 02/07/2013 14:45 Laboratory diagnosis of sexually transmitted infections, including human immunodeficiency virus Editor-in-Chief Magnus Unemo Editors Ronald Ballard Catherine Ison David Lewis Francis Ndowa Rosanna Peeling WHO Library Cataloguing-in-Publication Data Laboratory diagnosis of sexually transmitted infections, including human immunodeficiency virus / edited by Magnus Unemo … [et al]. 1.Sexually transmitted diseases – diagnosis. 2.HIV infections – diagnosis. 3.Diagnostic techniques and procedures. 4.Laboratories. I.Unemo, Magnus. II.Ballard, Ronald. III.Ison, Catherine. IV.Lewis, David. V.Ndowa, Francis. VI.Peeling, Rosanna. VII.World Health Organization. ISBN 978 92 4 150584 0 (NLM classification: WC 503.1) © World Health Organization 2013 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for non-commercial distribution – should be addressed to WHO Press through the WHO web site (www.who.int/about/licensing/copyright_form/en/index.html).
    [Show full text]
  • 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.
    [Show full text]
  • Practical Application of Quantitative Hisens Auto Rapid Plasma Reagin
    1) ORIGINAL ARTICLE DOI : 10.3947/ic.2009.41.3.154 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 Hyun Yong Hwang, M.D., Mi Hyang Kim, M.D. Department of Laboratory Medicine, Kosin University College of Medicine, Busan, Korea Background : The purpose of this study was to evaluate validity of quantitative RPR LTIA, HiSens Auto RPR LTIA (HBi Corp., South Korea) and to decide an adequate cutoff value for syphilis screening. Materials and Methods : A total of 549 serums or plasma specimens from patients were tested with RPR LTIA and RPR card tests. Degree of agreement between the two methods was analyzed, and validity of RPR LTIA test was analyzed by receiver operating characteristic (ROC) curves. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and ROC statistics of the RPR LTIA test were analyzed to decide an adequate cutoff value. Results : Agreement analysis showed slight to moderate agreement (k=0.093-0.588, P=0.000). Kappa value had its highest value at the cutoff value of 1.3 and 1.6 (k=0.588, P=0.000). Kappa value at the cutoff value of 1 ranked second (k=0.578. P=0.000). A plot of ROC curve showed a statistically valid result to differentiate between a syphilis test positive group and a syphilis test negative group (AUC=0.92, P=0.000). The cutoff values in RPR LTIA test ranged between 0.65 and 1.15 when both sensitivity and specificity were higher than 80%.
    [Show full text]
  • Seroprevalence of Treponema Pallidum Among
    Annals of African Medicine Vol. 4, No. 4; 2005:177 – 179 SYPHILIS IN A NIGERIAN PARAMILITARY AGENCY: NEED FOR TREATMENT POLICY 1 2 3 1 1 E. E. Nwokedi, Z. Iliyasu, A. U. Dikko, A. O. Azeez and B. Mohammed Departments of 1Medical Microbiology and Parasitology, 2Community Medicine and 3Physiology, Faculty of Medicine, Bayero University, Kano, Nigeria Reprint requests to> Dr. E. E. Nwokedi, Departments of Medical Microbiology and Parasitology, Aminu Kano Teaching Hospital, P. M. B. 3452, Kano, Nigeria. E-mail: [email protected] Key words: Syphilis, sexually Abstract transmitted diseases, Background: Sexually transmitted diseases are widespread in the developing seroprevalence countries and constitute a major public health problem in Sub-Saharan Africa. More recently, there has been a resurgence of syphilis. The aim of this study was to determine the seroprevalence rate of syphilis among newly recruited senior cadres of a Nigerian Security Agency. Method: Eight hundred and fifteen newly recruited men and women sent for serological test for syphilis (STS) in our laboratory were all screened accordingly using Rapid Plasma Reagin (RPR) test. All those that were positive wee confirmed using treponema pallidum haemagglutination (TPHA) test. Results: The seroprevalence rate of treponema pallidum infection was 4.0% (95%CI = 2.8% -5.6%). The rate was significantly higher among women 2 (8.0%) compare to men (3.4%) (X = 5.3 df = 1 P = 0.02). Considered by age, the highest seroprevalence of 6.7% was seen among oldest recruits (30- 39) years age group compared to 4.2% among the younger ones. This trend 2 was however, not statistically significant (X trend = 1.6 df =3 P = 0.20).
    [Show full text]
  • SYPHILIS HEALTH CHECK Rev. O, 04/15
    SYPHILIS HEALTH CHECK Rev. O, 04/15 CLIA Complexity: WAIVED for Fingerstick Whole Blood Specimens ONLY For in vitro diagnostic use only Rx Only A Certificate of Waiver is required to perform this test in a CLIA waived setting. To obtain a Certificate of Waiver, please contact your state health department. Additional CLIA waiver information is available at the Centers for Medicare and Medicaid website at www.cms.gov/CLIA or from your state health department. Failure to follow the instructions or modification to the test instructions will result in the test no longer meeting the requirements for waived category. INTENDED USE Syphilis Health Check is a qualitative rapid membrane immunochromatographic assay for the detection of Treponema pallidum (syphilis) antibodies in human whole blood, serum or plasma. This product can be used as an initial screening test or in conjunction with a nontreponemal laboratory test and clinical findings to aid in the diagnosis of syphilis infection. This test is not intended for use in screening blood or plasma donors. SUMMARY AND EXPLANATION Syphilis is a sexually transmitted disease (STD) caused by the spirochete organism Treponema pallidum (TP). As this organism cannot be cultured on artificial media, the diagnosis of syphilis depends on the correlation of clinical data with antibodies demonstrated by serological tests. Two types of antibody responses normally result: non-specific (anti-cardiolipin) (1,2) and specific (anti-treponemal). While non-specific antibodies occur in the majority of infected individuals, many other conditions can give rise to false positive results, yielding an overall specificity of about 50% in the general population(3).
    [Show full text]