The rapid plasma reagin rpr test is a macroscopic, nontreponemal flocculation card test used to screen for syphilis. A negative result on the treponemal test may mean that the initial rpr or vdrl test was falsely positive. Nonspecific non treponemal antibody screening tests i. However, one then needs to take a treponemal test to confirm that increased cardiolipin is in fact a result of a syphilis infection. Specific populations to target for screening include men. In non treponemal serologic test, such as venereal disease research laboratory vdrl and rapid plasma reagin rpr, the antibodies to be measured are non specific treponemal antibodies. The paradigm in syphilis testing has recently shifted in many centers to screen with a treponemal antibody test, reflexing to a nontreponemal test if the treponemal antibody test is positive. Comparative study of treponemal and nontreponemal test.
In north america, many unsuspected cases are discovered by laboratory testing. If a second treponemal test is negative and the epidemiologic risk and clinical probability for syphilis are low, the initial treponemal test is considered a false positive and further evaluation or treatment is not indicated. Evaluation of the whocdc syphilis serology proficiency. However there are important distinctions between currently available non treponemal test and the rapid treponemal tests as shown in text. If treponemal serology is to be interpreted correctly a sexual history is needed. What is the turnaround time for syphilis serology test results. This approach might be more attractive to laboratories that have high testing volumes and where the manual labor involved with nontreponemal tests is no longer appropriate for laboratory workflow and staffing needs. Syphilis serologic testing guidelines for interpretation. However, since endpoint titers may vary between these two tests, the same test used in the initial testing should be used to monitor treatment. Non treponemal serologic tests for syphilis include vdrl venereal disease research. A nonspecific nontreponemal test, such as the rapid plasma reagin rpr test or venereal disease reference. The serological tests most commonly used to screen for the disease are the.
A positive treponemal test will likely be followed by a non treponemal test to confirm a diagnosis. Screening with a nontreponemal test alone is not recommended because of the potential for false negative results as a result of the prozone phenomenon. Specimen collection procedure for syphilis serology. Who performance evaluation of treponemal and non treponemal rapid diagnostic tests rdts the performance evaluation determines the accuracy of treponema pallidum tp and non treponemal non tp serology rapid diagnostic tests rdt used in diagnosis of syphilis in comparison with established performance criteria. For non treponemal tests, rpr or usr were consistently performed by 54% of laboratories while the vdrl was performed by about 38%. Treponemal syphilis specific antibodies remain in the blood for life, whereas non treponemal non syphilis specific antibodies typically clear the blood after approx. Serologic testing for syphilis with traditional and reverse algorithms. Nontreponemal tests detect antibodies directed against lipoidal antigens, damaged host cells, and possibly from treponemes.
Both rpr and trust are non treponemal standard status diagnostic tests for syphilis, with similar levels of sensitivity and specificity in qualitative assays. This is also used to check the progress of treatment for active syphilis patients. A positive result on the second method confirms the screening result and the affected person is diagnosed with syphilis. Consensus statement on the clinical implications of a. The old version of this type of test was the vdrl venereal disease research laboratory test but the more modern and reliable equivalent test is the rpr rapid plasma reagin test. The laboratory diagnosis of syphilis pubmed central pmc. May 22, 2019 the specific treponemal test for syphilis syphilis tp cmia is available to all health care providers but is not designed to be a screening procedure and thus is only performed when required for proper patient management. All serological tests are positive at secondary stage and sensitivity for all tests including vdrl test which is approximately 100%. Mar 27, 2012 however, one then needs to take a treponemal test to confirm that increased cardiolipin is in fact a result of a syphilis infection. Please discuss all csf serology reqeusts with the oncall virology registrar or consultant. A new reflex testing algorithm for syphilis screening. This treponemal test performs quite well when used for sera found to be positive on screening, less well to confi rm the presence of negative sera.
Consensus statement on the clinical implications of a positive syphilis serology test in the context of a previous negative syphilis point of care test 1 introduction. The nontreponemal tests such as rapid plasma reagin test rpr or the. Reactive non treponemal tests for individuals with at least one non reactive treponemal test and no reactive treponemal test, were extracted from std surveillance systems in florida and. Over the 8year interval, participating laboratories performed a total of six types of tests. Syphilis serological testing cleveland clinic laboratories. It detects the igm and igg antibodies to lipoidal material released from the damaged host cells, as well as to lipoproteinlike material and possibly cardiolipin released from the treponemes. Serum is preabsobed with reiter strain non pathogenic to enhance specificity make sure negative values stay negative by preventing anti treponemal ab that are non specfic to t. The etiological agent, treponema pallidum, cannot be cultured, and there is no single optimal alternative test. Guidelines for evaluation and management of neonates exposed.
May 22, 2019 both rpr and trust are non treponemal standard status diagnostic tests for syphilis, with similar levels of sensitivity and specificity in qualitative assays. Pdf characterization of treponema pallidum particle. Confirmation of the diagnosis is through serologic testing. Non specific or non treponemal serological test to detect reagin, utilized as. Hence, the serologic diagnosis of syphilis requires the detection of 2 types of antibodies nontreponemal antibodies and treponemal antibodies. Vdrl flocculation test for the detection of nontreponemal. Traditionally syphilis serology is a twostep algorithm where the patients serum is initially screened with a nontreponemal test e. The traditional algorithm begins with a non treponemal assay, and if it is positive, the treponemal test is done. Guidelines for serological testing for syphilis sexually. Proper serologic diagnosis of syphilis in adults requires both a treponemal test and a non. The mainstay of diagnosis for treponema pallidum infections is based on nontreponemal and treponemal serologic tests. Types of syphilis serology tests medical health tests. It is based upon the reactivity, both igm and igg, of sera from patients with syphilis to non specific cardiolipincholesterollecithin antigens. Syphilis treponema pallidum serologic testing changes to testing.
If both rpr and tppa tests fail to confirm a reactive screening result, another treponemal test, fluorescent treponemal antibody absorption ftaabs has been. The recent introduction of pointofcare tests for syphilis has raised the issue of the clinical. Stands for fluorescent treponemal antibody absorption test. This is because treponemal tests eg, eia, mfi, or fluorescent treponemal antibodyabsorbed. This is a confirming test for syphilis since it tests specifically for antibodies in the patients serum made in response to the syphilis spirochete, treponema pallidum. Serology tests cannot differentiate between these treponemal infections. Serological tests for acquired syphilis in immunocompetent. There are 2 different types of serologic tests classified based on the type of antigen the antibodies are directed against. The advantage of non treponemal tests is that they are quantitative and can therefore be used to monitor response to treatment as the tests become negative with successful therapy. This nontreponemal antibody rpr is the reflex confirmation test to the syphilis antibody screen. The traditional algorithm using a nontreponemal test ntt followed by a treponemal test tt remains the standard in many parts of the world.
However, recently laboratories in nova scotia have moved to using the reverse algorithm. Now, with the availability of enzymelinked immunosorbent. Non specific or non treponemal serological test to detect reagin, utilized as screening test only, not diagnostic. Direct examination of clinical specimen by darkfield microscopy or fluorescent antibody testing of sample. Pdf syphilis serology in patients with primary syphilis and.
Nonspecific tests detect antibodies that bind to antigens that are, or are similar to, those expressed by treponema pallidum or expressed on host tissues during infection. Syphilis serology testing 3 treponemal assays, that either directly detect the pathogen or antibodies to the pathogen, have also evolved over the course of the 20th century and now 21st century. In contrast to the non treponemal tests, treponemal test reactivity will persist following treatment in approximately 85% of the cases often for the. Serological testing is the most frequently used approach in the laboratory diagnosis of syphilis. Because these tests measure the hosts antibody response to non treponemal. Both types of tests can be performed on one sample of patient serum. The non treponemal tests are reactive in secondary syphilis almost without exception, and usually at titers of 16 or greater regardless of the test method used.
Recent trends in the serologic diagnosis of syphilis. Screening for syphilis with the treponemal immunoassay. Syphilis usually diagnosed by serology nontreponemal e. As no single test is able to diagnose active syphilis, a combination of treponemal and nontreponemal. I think the lab from health department may confirmed the specific treponemal test and the result was non reactive that was meant that you were not get syphilis disease. Historically, the serologic testing algorithm for syphilis included an initial non treponemal screening test, such as the rapid plasma reagin rpr or the venereal disease research laboratory vdrl tests. Many new diagnostic methods for syphilis have been developed, using specific treponemal antigens and novel formats, including rapid pointofcare tests, enzyme immunoassays, and chemiluminescence assays.
Complexities in the diagnosis of syphilis continue to challenge clinicians. Fact sheet and frequently asked questions faq syphilis health check shc facts. Non treponemal serologic tests for syphilis include vdrl venereal disease research laboratory test and rpr rapid plasma reagin test. Nov 01, 2011 syphilis screening in the us has traditionally involved a non specific, nontreponemal anticardiolipin serological test eg, rapid plasma reagin rpr or venereal disease research laboratory vdrl with subsequent confirmation of positive results by a specific treponemal test eg, treponema pallidum particle agglutination tppa or the. This non treponemal antibody rpr is the reflex confirmation test to the syphilis antibody screen. The ftaabs test fluorescent treponemal antibody absorption test for syphilis is an example of an indirect fluorescent antibody procedure. Jan 15, 2011 with the increasing implementation of treponemal specific eias or cias as firstline syphilis screening tests in clinical laboratories, health care providers will inevitably be faced with patients who have positive results on a treponemal specific screening test, yet have negative results on nontreponemal tests. Treponemal tests detect antibody to t pallidum proteins.
The dual poc test detected nontreponemal antibody in all cases of untreated disease but was. A positive rpr or vdrl screen must be followed by a specific treponemal antibody test e. This feature of treponemal serology makes it very useful for patients and doctors to have documentation of complete treatment for syphilis. Following treatment, it should show a regular decline until it becomes negative or stabilizes at a low level treponemal test tt remains the standard in many parts of the world. The non treponemal tests such as rapid plasma reagin test rpr or the venereal disease reference laboratory test are the most commonly used test for screening of syphilis in the blood centers in india. Historically, the serologic testing algorithm for syphilis included an initial nontreponemal screening test, such as the rapid plasma reagin rpr or the venereal. Rpr or usr, vdrl, tppa or tpha, elisa, ftaabs and rapid treponemal tests any type. The reverse serology algorithm detects early, primary, and treated syphilis that may be missed with traditional screening. The advantage of non treponemal tests is that they are quantitative and can therefore be used to monitor response to treatment as the tests become negative with. Nontreponemal tests are an indirect method in that they detect biomarkers that are released during cellular damage that occurs from the syphilis spirochete. Canada, laboratory diagnosis, nontreponemal tests, serology.
Syphilis testing, new and old, rapid and not so rapid. Guidelines for evaluation and management of neonates. Serology technical leader page 3 of 28 controlled versions of department of forensic biology manuals only exist electronically on the forensic biology network. A nontreponemal test ntt is a blood test for diagnosis of infection with syphilis. Ftaabs may remain active for life, even following adequate therapy. Therefore, the results of a non treponemal assay, such as the rapid plasma reagin. Non specific tests detect antibodies that bind to antigens that are, or are similar to, those expressed by treponema pallidum or expressed on host tissues during infection. In individuals with a positive serum treponemal antibody, csf serology may guide the diagnosis of neurosyphilis. Nontreponemal antibody regional medical lab test directory. The serological tests most commonly used to screen for the disease are the non treponemal and treponemal tests. Vdrl test and its interpretation pubmed central pmc. The non treponemal tests such as rpr or the vdrl test measure the hosts response to non treponemal antigens such as cardiolipin and lecithin released from the damaged host cells, as well as lipoproteinlike material released from the. Methodist and childrens hospitals, omaha, ne, changed its screening protocol from using a non treponemal test rpr first to instead using a treponemal test a syphilis igg enzyme immunoassays eia first see table 1. The findings from this study will help inform the selection of the most appropriate second treponemal test for patients with initially discordant treponemal and nontreponemal serology, and selection of an automated treponemal test when the reverse sequence algorithm is used for a laboratory diagnosis of syphilis.
A drawback to non treponemal tests is that the level decreases with time. Performance of treponemal tests for the diagnosis of syphilis. Suggested reporting language for syphilis serology testing. Laboratory diagnostic testing for treponema pallidum. Novel pointofcare test for simultaneous detection of. Consensus statement on the clinical implications of a positive syphilis serology test in the context of a previous negative syphilis point of care test 2 rationale. Non treponemal test titers in early latent syphilis are similar to those of secondary syphilis. Non treponemal tests such as the rpr can be considered rapid tests as they can provide a result in less than 10 minutes. Comparative study of treponemal and nontreponemal test for. Pathogenic nichols strain from rabbit testicles is fixed to a slide. Treponemal serology can leave one unsure of diagnosis and management. Syphilis health check faq california department of. Laboratory diagnosis and interpretation of tests for syphilis. Unlike nontreponemal assays, which with few exceptions are currently manual, automated assays require far less operator interaction, are easier.
Traditionally syphilis serology is a twostep algorithm where the patients serum is initially screened with a non treponemal test e. The non treponemal test is a good followup indicator because the titer reflects the activity of the disease. During this test reagins, the non treponemal antibody or antibodies react with a phospholipid, called cardiolipin to form aggregation. Guidelines for evaluation and management of neonates exposed to syphilis babies born to mothers with positive syphilis tests are at risk for congenital syphilis. Confused by syphilis serology youre not the only one. Specimen collection procedure for syphilis serology testing. Syphilis serologic testing guidelines for interpretation 1. The reactivity of a non specific reagin rpr test and a specific treponemal ftaabs test were determined in 21 patients with primary syphilis, 430 patients with proven non treponemal genital.
There are two types of syphilis serology test nonspecific nontreponemal serology and specific treponemal serology. Syphilis serology an overview sciencedirect topics. Most rapid syphilis tests are made in a dipstick or cassette format. Maternal evidence of syphilis includes reactive non treponemal and treponemal syphilis serology tests or positive darkfield or other direct test of suspicious lesions. The serological diagnosis of syphilis requires the detection of two distinct antibodies, heterophile. The current non treponemal assays are non specific for syphilis. Suggested reporting language for syphilis serology testing aphl. The delaware public health laboratory performs a highly sensitive but somewhat non specific rapid screening test and a highly sensitive and specific confirmatory test for syphilis serology testing. However, non treponemal test is necessary to detect patients. Clinical indications a reactive syphilis igg result indicates that a person has. General introduction to serological testing 5 p a g e radial immunodiffusion tests are commercially available for the accurate measurement of immunoglobulins in the serum of neonates. Serologic testing for syphilis arlington scientific. The venereal disease research laboratory test abbreviated vdrl test is a syphilis serology blood test and was developed by harris, rosenberg, and riedel in 1946. These commercial kits are however expensive and practitioners may rather want to choose a cheap test such as the serum turbidity test.
A recent metaanalysis reported sensitivities and specificities comparable to those of laboratorybased treponemal tests. Screening with a non treponemal test alone is not recommended because of the potential for false negative results as a result of the prozone phenomenon. There are two types of syphilis serology test non specific non treponemal serology and specific treponemal serology. The australian therapeutic goods administration has registered the alere determine syphilis tp for use as a point of care syphilis test in australia. An initial screening with a treponemal serology test is followed by a nontreponemal. Performance of treponemal tests for the diagnosis of. Need both non treponemal rpr or vdrl and treponemal test tppa, ftaabs, eia, cia to make syphilis diagnosis treponemal tests can remain positive for life.
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