The Value of Routine Serological Testing for Syphilis in a Mental Hospital

Abstract

The practice of making routine serological tests for syphilis on all admissions is carried on in many mental hospitals, but no assessment of the advantage of this procedure at the present time seems to have been reported. Rosahn (1958), viewing the matter from the laboratories of a general hospital, concluded that syphilis was still a sufficiently important disease to justify routine screening tests. Bell (1959) studied the admissions in a 12-month period to a large Canadian general hospital He pointed out that some previous figures (Editorial, J. Amer. med. Ass., 1957), based on total numbers of positive reactors, did not give a realistic measure of the value of the testing procedure, and he attempted to determine the proportion of admission screening tests which were of practical significance, in that the clinicians concerned were led to initiate treatment as a result of them. He found a “useful discovery rate” (discounting two patients who he thought might well have had elective serology performed in any case) of 0·03 per cent.

Neurosyphilis and psychosis

“…One way of overcoming this problem is to perform routine screening for high-risk patients. However, in real practice, cost has always been the debate Banks, 1968). Routine screening is costly; however, the outcome of undiagnosed syphilis, especially when detected late, also leads to financial burden.…”

Review of hospitalized cases of general paralysis of the insane.

“…The development of Charcot's arthropathy was confined to men. Banks (1968) (Hahn and others, 1959 Since publication of the work of Collart, Borel, andDurel (1962a, b, c, 1964) (Collart, Borel, andDurel, 1962a, b, c, 1964;Smith and Israel, 1968;Gager, Israel, and Smith, 1968). None the less it seems reasonable to raise the possibility that persistence of viable treponemes after treatment may account for the downhill course in certain cases of GPI.…”

“…The development of Charcot's arthropathy was confined to men. Banks (1968) doubted the value of routine screening for syphilis in mental hospitals because the useful discovery rate was only 0-11 per cent., the same as in this series. Nevertheless caution should be exercised before abandoning screening, for eminently treatable cases may be overlooked (Dawson-Butterworth, 1967b;Pritchard, Mechie, McHugh, and Boot, 1967), especially at a time when clinical awareness is likely to be diminished by the scanty opportunities of gaining experience of what was once a more common disease.…”

Seronegative dementia paralytica: report of a case

“…Among the non-treponemal tests, the VDRL is one of the most commonly used tests for the detection of reagin in human serum by using non-specific of patients with late syphilis may be non-reactive to the non-treponemal tests (Olansky and Normns, 1966). Despite this, the test is still widely used as a screening device in many institutions including mental hospitals (Banks, 1968). For more specific purposes one must rely on tests utilizing a treponemal antigen.…”

“…Harner, Smith, and Israel (1968) (Banks, 1968). Smith and Israel (1968) were able to demonstrate motile treponemes in the aqueous humor and treponemes by fluorescentantibody staining of a liver biopsy specimen from a patient with treated tabes on whose serum the FTA-ABS, TPI, and VDRL tests were all negative.…”