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Serologic Testing For Syphilis Benefits and
Serologic Testing For Syphilis Benefits and
Microbiology
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b. Secondary stage: palmar rash, full body rash c. Teritary stage: gummatous lesions in the heart and
on the skin
Syphilis is primarily acquired as a sexually transmitted dis- help to avoid serious consequences to the fetus or the newborn.
ease (STD), so it is perhaps not surprising that data suggest an Public health campaigns, such as the Syphilis Elimination Effort,
increased incidence of syphilis in certain high-risk populations, and global initiatives by the World Health Organization (WHO)
such as men who have sex with men and commercial sex workers and the Pan American Health Organization in partnership with
(3). Beyond the greater generalized likelihood of contracting an the United Nations Children’s Fund seek to eliminate mother-
STD through high-risk (e.g., unprotected) sexual behavior, hav- to-child-transmission of syphilis by 2015, in part through tar-
ing HIV does not appear to place an individual at higher risk of geted prenatal testing and educational efforts, as well as through
contracting syphilis (4,5). However, the likelihood of HIV trans- improved availability of antenatal care (6). Despite such efforts,
mission by an HIV-infected individual to an unprotected sexual syphilis continues to present an important public health challenge
partner may be increased if the partner has a syphilitic chancre that in the United States and many other countries.
becomes exposed to HIV-bearing secretions (3,5). Thus, syphilis
Regardless of the mode of transmission and despite the disappear-
screening for at-risk and high-risk individuals plays an important
ance of symptoms in latency, T. pallidum infection persists until
role in public health.
it has been treated. Antibiotic treatment can usually eliminate
Syphilis is usually transmitted sexually; however, it can also be existing infection at any stage; however, there is no immunity
passed vertically from mother to child either transplacentally associated with successful therapy, so reinfection can occur with
(in utero) or perinatally as the newborn comes into contact with subsequent exposure. The vast majority of infections are respon-
maternal blood and vaginal fluid during birth. Mother-to-child sive to penicillin, which is still the drug of choice. Fortunately,
transmission of syphilis can have serious consequences. Approxi- no penicillin-resistant strains of T. pallidum have been reported;
mately 69% of untreated infected pregnant women will experience however, penicillin crosses the blood-brain barrier only minimally
an adverse pregnancy outcome, which can include serious birth and so may be of limited use for the treatment of neurosyphilis.
defects, low birth weight, and prematurity. The consequences for For individuals allergic to penicillin, alternative antibiotics, such
a child infected with syphilis in utero can be lifelong. In addition, as tetracyclines (tetracycline and doxycycline) and macrolides
25% of in utero infections result in late-term miscarriage or still- (azithromycin and erythromycin), have been used for treatment.
birth, and 11% culminate in neonatal demise (3,6). Fortunately, Unfortunately, the use of alternative regimens, in particular the
routine screening and treatment of pregnant women have been macrolides, has produced antimicrobial resistance in some trepo-
shown to significantly reduce cases of congenital syphilis and can nemal strains (7).
Figure 2. Antibodies
detected in treponemal and
nontreponemal testing
In many countries, treponemal screening using a reverse algo- 5. Anonymous. 1998. HIV prevention through early detection and
treatment of other sexually transmitted diseases—United States.
rithm has become commonplace, though individual algorithms Recommendations of the Advisory Committee for HIV and STD
and discordant-specimen management vary. Both clinical and prevention. MMWR Recomm. Rep. 47(RR-12):1-24.
labor considerations contribute to the value of reverse screening 6. Hawkes, S. et al. 2011. Effectiveness of interventions to improve
for syphilis. In the U.S., the trend toward increased consolidation screening for syphilis in pregnancy: a systematic review and meta-
has meant that sample volume has often increased in laboratories analysis. Lancet Infect. Dis.11:684-691.
offering syphilis testing. The current lack of a commercial, auto- 7. Lewis, D.A. and S.A. Lukehart. 2011. Antimicrobial resistance in Neis-
seria gonorrhoeae and Treponema pallidum: evolution, therapeutic chal-
mated option for nontreponemal testing has driven interest in the lenges and the need to strengthen global surveillance. Sex. Transm.
growing availability of treponemal assays able to meet the demands Infect. 87(Suppl. 2):ii39-43.
of increased throughput. In addition to the nontreponemal assays 8. Ratnam, S. 2005. The laboratory diagnosis of syphilis. Can. J. Infect.
being more labor-intensive, many clinicians, laboratorians, and Dis. Med. Microbiol.16:45-51.
public health agencies have cited concerns over the looming short- 9. Peeling, R.W. and H. Ye. 2004. Diagnostic tools for preventing and
age of trained and experienced laboratory technologists who can managing maternal and congenital syphilis: an overview. Bull. World
Health Organ. 82:439-446.
accurately perform, interpret, and report the test results. While
10. Geusau, A. et al. 2005. Biological false-positive tests comprise a high
nontreponemal tests are clinically important for establishing the
proportion of venereal disease research laboratory reactions in an
stage of disease and response to therapy, as with any test, both false- analysis of 300,000 sera. Int. J. STD AIDS 16:722-726.
positive and false-negative results can be associated with them, 11. Larsen, S.A. and E.T. Creighton. 1998. Rapid plasma reagin (RPR)
stemming from time and temperature sensitivity, biologic false- 18-mm circle card test, p. 193-207. In S.A. Larsen, V. Pope, R.E.