Syphilis: New Diagnostic Directions

Young, H

doi:10.1177/095646249200300601

Cited by 60 publications

(53 citation statements)

References 145 publications

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“…It is likely that most of the TPPA-nonreactive, EIA-reactive cases were either old or treated cases of mostly HIV-positive patients. Aberrant results in laboratory tests for syphilis are well known to occur in HIV-infected individuals (15,20). We would, therefore, not advocate that syphilis confirmation algorithms change but rather highlight the fact that in repeatedly screened populations, such as HIV-positive individuals, discrepancies between treponemal EIA and TPPA results are quite prevalent.…”

Section: Discussionmentioning

confidence: 99%

“…Manavi and colleagues (16) have suggested that, in the absence of a specific treponemal IgM EIA, a TPPA test should be performed whenever there (Table 3). Traditionally, the FTA-ABS test is regarded as the "gold standard" for confirmatory syphilis serology (2,20). Reservations have been expressed (6) that when sensitive treponemal EIAs are used for screening, the FTA-ABS test may fail to confirm the screening reactivity.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Characterization of Treponema pallidum Particle Agglutination Assay-Negative Sera following Screening by Treponemal Total Antibody Enzyme Immunoassays

Maple

Ratcliffe

Smit

2010

Clin Vaccine Immunol

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Following a laboratory audit, a significant number of Treponema pallidum particle agglutination assay (TPPA)-negative sera were identified when TPPA was used as a confirmatory assay of syphilis enzyme immunoassay (EIA) screening-reactive sera (SSRS). Sera giving such discrepant results were further characterized to assess their significance. A panel of 226 sera was tested by the Abbott Murex ICE Syphilis EIA and then by the Newmarket Syphilis EIA II. TPPA testing was performed on 223 sera. Further testing by the Venereal Disease Research Laboratory (VDRL) test, the Mercia Syphilis IgM EIA, the fluorescent treponemal antibody (FTA-ABS) assay, and INNO-LIA immunoblotting was undertaken in discrepant cases. One hundred eighty-seven of 223 (83.8%) SSRS were TPPA reactive, while 26 (11.6%) sera which were reactive in both the ICE and Newmarket EIAs were nonreactive by TPPA. The majority (68%) of the TPPA-discrepant sera were from HIV-positive patients and did not represent early acute cases, based on previous or follow-up samples, which were available for 22/26 samples. FTA-ABS testing was performed on 24 of these sera; 14 (58.3%) were FTA-ABS positive, and 10 (41.7%) were FTA-ABS negative. Twenty-one of these 26 sera were tested by INNO-LIA, and an additional 4 FTA-ABS-negative samples were positive. In this study, significant numbers (18/26) of SSRS-and TPPA-negative sera were shown by further FTA-ABS and LIA (line immunoblot assay) testing to be positive. The reason why certain sera are negative by TPPA but reactive by treponemal EIA and other syphilis confirmatory assays is not clear, and these initial findings should be further explored.Treponema pallidum hemagglutination assay (TPHA), introduced during the 1960s, has been shown (17, 19) to be highly sensitive and specific at detecting treponemal antibodies and is still used by many laboratories. A modification of the TPHA is the Treponema pallidum particle agglutination assay (TPPA), which has been shown (1) to perform as well as the hemagglutination assay.In recent years, a number of highly sensitive and specific enzyme immunoassays (EIAs) (7) have become available, and some of these can simultaneously detect syphilis IgG and IgM, thus shortening the seronegative window following infection. Two such assays are the Abbott Murex ICE Syphilis EIA (1) and the Newmarket Laboratories Syphilis EIA II (18). United Kingdom guidelines have proposed (9, 10) that either an EIA alone or a combination of VDRL/rapid plasma reagin (RPR) tests and TPPA/TPHA can be used for syphilis screening. Furthermore, specimens that are reactive on screening require confirmatory testing with a different treponemal test that has a sensitivity equal to that used for screening and, ideally, that has greater specificity. The fluorescent treponemal antibody (FTA-ABS) test has been used widely as a confirmatory test; however, treponemal Western blot/immunoblot assays (5), which have been shown to perform as well as the FTA-ABS test, have proved an attractive alternative because of their reported...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Characterization of Treponema pallidum Particle Agglutination Assay-Negative Sera following Screening by Treponemal Total Antibody Enzyme Immunoassays

Maple

Ratcliffe

Smit

2010

Clin Vaccine Immunol

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show abstract

“…In addition, the serological tests in the diagnosis of congenital syphilis are confused by transferred antibodies from a syphilitic mother to her child. Direct methods of syphilis diagnosis involving microscopic identification of treponemes in clinical samples or rabbit infectivity tests (RIT) are suboptimal because of low sensitivity and low specificity (microscopy), or because of costly and delayed test results [4]. In addition, neither test can distinguish between syphilis and endemic treponematoses; nor can they distinguish between different T. pallidum strains and therefore cannot differentiate between re-infection and reactivation of syphilis and cannot be used for epidemiological studies.…”

Section: Limitations Of Present Laboratory Tests For Syphilismentioning

confidence: 98%

“…However, serology has several limitations including a delayed antibody response, which usually appears first during the second week of infection. With the exception of specific anti-treponemal IgM tests [4], positive routine serology of syphilis does not indicate an active infection process because a previous history of syphilitic infection is detected at the same time. Interpretation of serological tests in patients in geographical areas with the occurrence of endemic treponematoses is often quite complex.…”

Section: Limitations Of Present Laboratory Tests For Syphilismentioning

confidence: 98%

Diagnosis of syphilis by polymerase chain reaction and molecular typing of Treponema pallidum

Šmajs¹,

Matějková²,

Woznicová³

et al. 2006

Reviews in Medical Microbiology

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“…L'association du TPHA et du VDRL (ou RPR) permet de dépister une syphilis primaire ou secondaire avec une sensibilité de 84 % [56]. L'immunofluorescence indirecte ou FTA-abs.…”

Section: Les Tests De Dépistageunclassified

Le sérodiagnostic des infections sexuellement transmissibles : évaluation critique

Ebel¹,

Ly²,

Bianchi³

2004

Immuno-analyse & Biologie Spécialisée

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Syphilis: New Diagnostic Directions

Cited by 60 publications

References 145 publications

Characterization of Treponema pallidum Particle Agglutination Assay-Negative Sera following Screening by Treponemal Total Antibody Enzyme Immunoassays

Characterization of Treponema pallidum Particle Agglutination Assay-Negative Sera following Screening by Treponemal Total Antibody Enzyme Immunoassays

Diagnosis of syphilis by polymerase chain reaction and molecular typing of Treponema pallidum

Le sérodiagnostic des infections sexuellement transmissibles : évaluation critique

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