Presidential Address to the M.S.S.V.D: Systemic disease and the biological false positive reaction

Catterall, R D

doi:10.1136/sti.69.6.469

Cited by 6 publications

(9 citation statements)

References 13 publications

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“…7,8,12,23 In our study, 23 (18.5%) sera were found BFP by RPR, while all other tests done were negative. Two of them were from known HIV-infected patients.…”

Section: Discussionsupporting

confidence: 42%

“…Non-treponemal tests such as the rapid plasma reagin (RPR) test or the Venereal Disease Research Laboratory (VDRL) test measure the host's response to non-treponemal antigens released from damaged host cells, as well as lipoprotein-like material from the treponemas. [1][2][3] Although the non-treponemal tests are generally considered to be sensitive in early syphilis, disadvantages include false-positive reactions, [4][5][6] false-negative results due to the prozone phenomenon 7,8 and lack of sensitivity in late-stage infection. 9, 10 On the other hand, treponemal tests such as the microhaemagglutination assay for Treponema pallidum (MHA-TP) offer high sensitivity for all stages of disease other than very early primary syphilis.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the Serodia Treponema pallidum particle agglutination, the Murex Syphilis ICE and the Enzywell TP tests for serodiagnosis of syphilis

et al. 2005

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We evaluated the Treponema pallidum haemagglutination assay (TPHA), a treponemal test, with three other treponemal tests, the Serodia T. pallidum particle agglutination assay, the Murex Syphilis ICE IgG + IgM enzyme immunoassay (EIA) and the Enzywell TP IgG + M EIA (a new rapid EIA) for use in conjunction with the rapid plasma reagin test (RPR), a non-treponemal test, for serodiagnosis of syphilis. In all, 124 serum samples were found reactive with RPR and/or TPHA after testing by the routine laboratory protocol. Twenty-three (18.5%) of them were positive only by RPR test and were evaluated as biologically false-positive, 16 were positive only by the TPHA and 84 by both the RPR and TPHA tests; one sample was non-specific (heterophile reaction) in the TPHA. Agreements of the TPHA with the Serodia TPPA, the Murex Syphilis ICE and the Enzywell TP tests were 96.7%, 100% and 99.1%, respectively. We conclude that each one of the tests, the Serodia TPPA, the Murex Syphilis ICE and the Enzywell TP, is an appropriate substitute for screening for serodiagnosis of syphilis.

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“…7,8,12,23 In our study, 23 (18.5%) sera were found BFP by RPR, while all other tests done were negative. Two of them were from known HIV-infected patients.…”

Section: Discussionsupporting

confidence: 42%

Section: Introductionmentioning

confidence: 99%

Evaluation of the Serodia Treponema pallidum particle agglutination, the Murex Syphilis ICE and the Enzywell TP tests for serodiagnosis of syphilis

et al. 2005

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“…The nontreponemal (reagin) tests measure immunoglobulin M (IgM) and IgG antibodies to lipoidal material released from damaged host cells as well as to lipoprotein-like material (127) and possibly by cardiolipin released from the treponemes. The antilipoidal antibodies are antibodies that not only are produced as a consequence of syphilis and the other treponemal diseases, but also may be produced in response to nontreponemal diseases of an acute and chronic nature in which tissue damage occurs (16). Without some other evidence for the diagnosis of syphilis, a reactive nontreponemal test does not confirm T. pallidum infection.…”

Section: Nontreponemal Testsmentioning

confidence: 99%

“…The uninfected recipient was inoculated by single or multiple injection or by implanting biopsied material into the forearm or thigh (123). Although lesions developed, precise interpretation of results was difficult because of the diverse clinical symptoms of syphilis and the lack of serologic or microscopic proof of infection (16). The first transfer of T. pallidum from a human to the testicle of a rabbit was reported in 1907 (150).…”

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confidence: 99%

Laboratory diagnosis and interpretation of tests for syphilis

1995

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The lack of a method for demonstrating the presence of Treponema pallidum by growth necessitates the use of alternative methods. Traditionally, these methods are divided into direct detection methods (animal inoculation, dark-field microscopy, etc.) and serologic tests for the presence of patient antibody against T. pallidum. Serologic methods are further divided into two classes. One class, the nontreponemal tests, detects antibodies to lipoidal antigens present in either the host or T. pallidum; examples are the Venereal Disease Research Laboratory and rapid plasma reagin and tests. Reactivity in these tests generally indicates host tissue damage that may not be specific for syphilis. Because these tests are easy and inexpensive to perform, they are commonly used for screening, and with proper clinical signs they are suggestive of syphilis. The other class of test, the treponemal tests, uses specific treponemal antigens. Confirmation of infection requires a reactive treponemal test. Examples of the treponemal tests are the microhemagglutination assay for antibodies to T. pallidum and the fluorescent treponemal antibody absorption test. These tests are more expensive and complicated to perform than the nontreponemal tests. On the horizon are a number of direct antigen, enzyme-linked immunosorbent assay, and PCR techniques. Several of these techniques have shown promise in clinical trials for the diagnosis of congenital syphilis and neurosyphilis that are presently difficult to diagnose.

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“…5 In the general population, the prevalence of these BFP syphilis reactions has been reported to be less than 1%, 5,9,10 and may be chronic or transient. Transient BFP reactions are associated with conditions where tissue damage occurs, 11 such as in acute bacterial, viral and plasmodial infections, and last for less than six months. 9,12 Chronic BFP reactions persist beyond six months and have been found in patients with chronic infections, rheumatic disorders, autoimmune diseases, 5,[12][13][14][15] and in patients with malignancies.…”

Section: Introductionmentioning

confidence: 99%

Biological false-positive tests comprise a high proportion of Venereal Disease Research Laboratory reactions in an analysis of 300,000 sera

et al. 2005

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This retrospective study on syphilis screening at the sexually transmitted infection (STI) unit of a University Department emphasizes the necessity of a treponemal-specific test as the appropriate screening test. The Venereal Disease Research Laboratory (VDRL) test for syphilis screening may, under certain circumstances, yield positive results in patients not infected with Treponema pallidum, a phenomenon referred to as biological false-positive (BFP) VDRL test. The aim of this study was to determine the frequency of BFP tests in a large sample of sera. In this retrospective study, we analysed the results of parallel VDRL and T. pallidum haemagglutination (TPHA) testing of a total of 514,940 blood samples obtained from patients at the Vienna General Hospital between January 1988 and November 1999. Patients' sera with incomplete data on stage and sex and duplicate sera were excluded, leaving 300,000 sera for analysis. The seroprevalence for syphilis was 1.77% (n = 5320), as determined by a positive TPHA test. It was significantly higher in male than in female patients (2.03% versus 1.58%, P<0.001). Of the patients reactive in the TPHA test, 3257 (61.2%) were negative in the VDRL. With regard to reactivity in VDRL testing, 2799 patients (0.92%) of the study population were positive, of whom 736 (26%) were biological false positive. BFP reactivity was found in 0.24% of all patients and was significantly higher in women than in men (0.27% versus 0.20%, P<0.001) and in patients over 60 years of age (0.34%) as compared with those under 60 (0.25%, P<0.001). This proportion might be even higher, as reactivity in the VDRL at 1:0 and 1:2 dilutions without a positive treponemal test was not reported. The subgroup of HIV-positive patients (n = 1415) revealed a 10-fold higher rate of BFP tests (2.1% versus 0.24), an effect being statistically significant. In a low syphilis prevalence population, BFP reactions comprise a high proportion of all VDRL reactors. Therefore, the use of the VDRL as a screening procedure is challenged.

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Presidential Address to the M.S.S.V.D: Systemic disease and the biological false positive reaction

Cited by 6 publications

References 13 publications

Evaluation of the Serodia Treponema pallidum particle agglutination, the Murex Syphilis ICE and the Enzywell TP tests for serodiagnosis of syphilis

Evaluation of the Serodia Treponema pallidum particle agglutination, the Murex Syphilis ICE and the Enzywell TP tests for serodiagnosis of syphilis

Laboratory diagnosis and interpretation of tests for syphilis

Biological false-positive tests comprise a high proportion of Venereal Disease Research Laboratory reactions in an analysis of 300,000 sera

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