Syphilis Antibody


Syphilis Antibody, Syphilis Serology, Syphilis Screening, Syphilis False Positive, Syphilis Testing, Syphilis Diagnosis, Treponema test, Non-Treponemal Test

  • See Also
  • Indication
  1. Syphilis (Treponema pallidum) detection
  2. Syphilis Screening annually for all Men who have Sex with Men
  3. Skin lesions or other clinical findings suggestive of Syphilis
  4. Confirmation of positive Screening Test
  • Background
  1. Antigen Extracts from beef heart (cardiolipin)
    1. Non-specific Syphilis antibodies bind cardiolipin
  1. Non-Treponemal Derived Substance precipitates Antibody (False Negatives in first 4 weeks)
    1. Venereal Disease Research Laboratory (VDRL)
    2. Rapid Plasma Reagin (RPR)
    3. Automated Reagin Test (ART)
    4. Standard Test for Syphilis (STS)
  2. Treponemal antigen precipitates Antibody (False Negatives in the first 2 weeks)
    1. Fluorescent Treponemal Antibody (FTA-ABS)
      1. Test Sensitivity: 80%
    2. Microhemagglutination - Treponema pallidum (MHA-TP)
      1. Test Sensitivity: 65% to 70%
  1. Dark-field Microscopy
    1. Most specific if Chancre or condyloma is present
    2. Can result in immediate diagnosis in the first week without the 3 week delay witing for IgM to develop
    3. Accuracy varies with experience of technician
    4. May detect Syphilis at any stage
  • Protocol
  • Testing
  1. Screening
    1. If no prior Syphilis history or treatment, start with serologic testing or Treponemal tests
      1. Obtain Treponemal tests (Syphilis IgG) as initial test
      2. Treat if positive
    2. If prior Syphilis, start with RPR or VDRL
      1. Syphilis Screening (positive within 3 weeks of developing primary Chancre)
      2. Syphilis RPR positive test will be returned with titer (e.g. 1:16)
      3. After treatment, by 6 months, RPR should fall by a factor of 4 (e.g. 1:4)
      4. On subsequent infection, expect the RPR titer to once again rise
    3. HIV Screening (test all patients who are positive for Syphilis)
      1. HIV coinfection with Syphilis is common
      2. HIV patients are at higher risk of Neurosyphilis
  2. Negative test with lesions present or other strong clinical indicators
    1. Repeat screening in 2-3 weeks
  3. Confirmation of positive Screening Test
    1. Fluorescent Treponemal Antibody (FTA-ABS)
    2. Microhemagglutination - Treponema pallidum (MHA-TP)
  4. Neurosyphilis CSF Evaluation
    1. See Neurosyphilis
    2. Indications for Lumbar Puncture with CSF Exam
      1. All patients with Syphilis and neurologic symptoms
      2. All patients with serologic or exam findings consistent with treatment failure
      3. HIV patient specific criteria
        1. CD4 Count <350 cells/mm3 or
        2. Rapid plasmin reagin (RPR) >1:32
  5. Monitoring response to treatment
    1. Non-Treponemal Antibody test (e.g. RPR) will normalize after treament
    2. Treponemal tests will remain positive despite treatment
  1. Other Spirochete infections (Leptospirosis, Lyme Disease, rat bite fever)
  • Efficacy
  1. Diagnostic Test Sensitivity in Primary Syphilis
    1. Dark-field Exam of Chancre: 80%
    2. Non-Treponemal Tests (e.g. RPR): 78-86%
    3. Treponemal tests (e.g. FTA-ABS): 76-84%
  2. Diagnostic Test Sensitivity in Secondary Syphilis
    1. Dark-field Exam of Chancre: 80%
    2. Non-Treponemal Tests (e.g. RPR): 100%
    3. Treponemal tests (e.g. FTA-ABS): 100%
  3. Diagnostic Test Sensitivity in Latent Syphilis
    1. Non-Treponemal Tests (e.g. RPR): 95-100%
    2. Treponemal tests (e.g. FTA-ABS): 97-100%
  4. Diagnostic Test Sensitivity in Tertiary Syphilis
    1. CSF evaluation required (see below)
    2. Non-Treponemal Tests (e.g. RPR): 71-73%
    3. Treponemal tests (e.g. FTA-ABS): 94-96%
  • Reference
  1. Mason and von Reinhart (2018) EM:Rap 18(6): 19-20
  2. Bakerman (1984) ABCs of Interpretive Lab Data, p. 392
  3. Larsen (1995) Clin Microbiol Rev 8:1-21 [PubMed]