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Lecture outline
•Introduction
•Diagnosis in the adult
•Interpretation of serological tests
•Syphilis/HIV interactions
•Diagnosis in the infant
Treponema pallidum
• Antibody detection
• Detects antibodies against pathogenic treponemes
•always reported as ‘treponemal’ serology
• Incubation period 9 - 90 days
• Natural history - many decades
• Suspect neurosyphilis - test serum before CSF
Methods of detecting T. pallidum in
primary infection
Dark ground Sensitivity Exudate; live treponemes;
microscopy 79-97% morphology; dark ground
microscope; experienced
clinican and observer;
genital lesions; 15 mins
DFA-Tp Sensitivity Exudate; fixed treponemes;
(MoAb to morphology; fluorescent
73-?100%
47KDa microscope; experienced
antigen) observer; oral and rectal
lesions; 30 mins; no kit
PCR Sensitivity Exudate; specialised
75-95% equipment; objective; high
specificity (T. pallidum
subsp.); 2-4 hours; no kit
EIA or TPPA
Screening tests for syphilis
What is available?
• Non-treponemal tests
• Cardiolipin antigen “Reagin” “Lipoidal”
• VDRL slide test (read microscopically)
• Rapid plasma reagin or carbon antigen test
(RPR or VDRL/RPR)
• Treponemal tests
• Antigen from Nichols strain of T. pallidum
• TPHA (erythrocytes as carrier)
• TPPA (gelatin particles as carrier)
• EIA (native and recombinant antigen)
• Rapid immunochromatic strip tests
VDRL slide test
Positive Negative
TPPA
• Specificity > 99.5%
• Sensitivity – 90-95% in primary syphilis
• Easier to perform and read than TPHA
• Variety of EIAs
• Native vs. recombinant T. pallidum antigens
• Screening tests detect total IgG and IgM
• Objective reading
• Suited to automated testing/ electronic reporting
• Can test for other blood borne infections on same analyser
• Not suitable for titration (staging/treatment monitoring)
What to use as a primary screening test
• EIA (first choice)
• TPPA (second choice)
• TPPA/TPHA plus VDRL (third choice)
• Depends on
• Resources and test volume
• Screening test used