Serologic Response to Treatment of Infectious Syphilis

Romanowski, Barbara; Sutherland, Ruth; Fick, Gordon H.; Mooney, Debbie; Love, Edgar J.

doi:10.7326/0003-4819-114-12-1005

Cited by 222 publications

(130 citation statements)

References 9 publications

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“…Explanations include inaccurate recall, insufficient explanation given to patients and their partners when they receive treatment, previous false-positive RPRs, over-treatment of syphilis as a result of the use of the WHO algorithm for syndromic treatment of sexually transmitted infections, and perhaps reversion of serological tests to non-reactive after treatment. [33][34][35] We compared our study results with the WHO laboratory-based evaluation of rapid syphilis diagnostics 23 using a random subsample of 400 sera, and we found no significant differences with the sensitivity (c² test P = 0.09) and specificity (P = 0.5) of our ICSRef . Compared with other field studies, our data on the sensitivity of the RPRHF for active syphilis showed no significant differences to those reported in the Gambia (P>0.3) 36 and in Senegal (P>0.5), 37 but our sensitivity was lower than that reported in a South African study (P<0.01).…”

Section: Discussionmentioning

confidence: 98%

Syphilis screening in Mozambique

Montoya

Lukehart

Brentlinger

et al. 2006

Bull World Health Organ

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Objective Programmes to control syphilis in developing countries are hampered by a lack of laboratory services, delayed diagnosis, and doubts about current screening methods. We aimed to compare the diagnostic accuracy of an immunochromatographic strip (ICS) test and the rapid plasma reagin (RPR) test with the combined gold standard (RPR, Treponema pallidum haemagglutination assay and direct immunofluorescence stain done at a reference laboratory) for the detection of syphilis in pregnancy. Methods We included test results from 4789 women attending their first antenatal visit at one of six health facilities in Sofala Province, central Mozambique. We compared diagnostic accuracy (sensitivity, specificity, and positive and negative predictive values) of ICS and RPR done at the health facilities and ICS performed at the reference laboratory. We also made subgroup comparisons by human immunodeficiency virus (HIV) and malaria status. Findings For active syphilis, the sensitivity of the ICS was 95.3% at the reference laboratory, and 84.1% at the health facility. The sensitivity of the RPR at the health facility was 70.7%. Specificity and positive and negative predictive values showed a similar pattern. The ICS outperformed RPR in all comparisons (P<0.001). Conclusion The diagnostic accuracy of the ICS compared favourably with that of the gold standard. The use of the ICS in Mozambique and similar settings may improve the diagnosis of syphilis in health facilities, both with and without laboratories.Keywords Syphilis serodiagnosis; Prenatal diagnosis; Mozambique (source: MeSH, NLM). Mots clés Séro-diagnostic syphilis; Diagnostic prénatal; Mozambique (source: MeSH, INSERM). Palabras clave Serodiagnóstico de la sífilis; Diagnóstico prenatal; Mozambique (fuente: DeCS, BIREME). Voir page 103 le résumé en français. En la página 103 figura un resumen en español.

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Section: Discussionmentioning

confidence: 98%

Syphilis screening in Mozambique

Montoya

Lukehart

Brentlinger

et al. 2006

Bull World Health Organ

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“…One study was carried out by Romanowski et al; they observed that treponemal antibodies level also decreases in response to treatment. There was a positive correlation between the treatment introduction and the duration of treponemal antibodies memories, with early decrease of treponemal antibodies in prime-infection rather than in re-infection [30]. Other studies were performed by Western Blot technique, which provides analyses of reactivity against each specific antigenic fraction.…”

Section: Discussionmentioning

confidence: 99%

Profile of Anti-Tp47 antibodies in patients with positive serology for syphilis analized by western blot

Miranda¹,

Sato²

2008

Braz J Infect Dis

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In Brazil, syphilis is still a great problem of public health. Serological test is essential for syphilis diagnosis and the current trend is the use of recombinant antigen in the treponemal tests, due to its confirmed higher sensibility and specificity. The purpose of the present study was to analyze the profile of anti-Tp47 antibodies in patients with positive serology for syphilis. One hundred positive sera samples were analyzed by Western Blot (WB) technique, using the recombinant antigen (rTp47). Ten of them did not present antibodies against the fraction rTp47, the results were confirmed by WB using native T. pallidum antigen. All ten samples had antibodies against the fractions Tp17 and Tp15 and presented low reactivity in VDRL, negative results or title below than 1:4. Considering that VDRL is used for therapeutic monitoring due to seroreversion of nontreponemal antibodies in response to the treatment, and that some studies reported loss of treponemal antibodies after treatment, we could speculate if these ten samples are cases of serological memory from patients previously treated for syphilis. In addition, although several features state the Tp47 fraction as one of the major antigenic components, based on our results we point out to the importance of including other antigenic proteins such as Tp17 and Tp15 in addition to Tp47 in tests for serological screening of syphilis.

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“…However, another study found no association between HIV seropositivity and seroreversion of treponemal antibodies, in patients treated for early syphilis (Augenbraun et al, 1998). Also, seroreversion of treponemal antibodies had been reported in immunocompetent patients treated for early syphilis (Schroeter et al, 1972) or first episode of syphilis (Romanowski et al, 1991).…”

Section: Pre-haartmentioning

confidence: 98%

“…Schoeter et al reported that 14% of patients with early syphilis lost their reactivity in the FTA-abs test within 2 years after treatment (Schroeter et al, 1972). Another study demonstrated that in patients with first episode syphilis, 24% of had a non-reactive FTA-abs and 13% had a nonreactive MHA-Tp in 3 years (Romanowski et al, 1991). A prospective, cohort treatment study of 261 patients with early syphilis that had 1 year serologic follow-up with FTA-abs or MHA-TP found seroreversion in 9% and 5% of cases, respectively.…”

Section: Anti-treponemal Antibodiesmentioning

confidence: 99%