Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:50

1396 Syphilis

tests

Basic Tests

■CSF examination: pleocytosis (>5 WBC/mm3), elevated protein,

+VDRL

Specific Diagnostic Tests

■Darkfield examination: examine fresh specimen of serous exudate

from lesions; identify characteristic corkscrew motility of spirochete;

test of choice (if available) for primary syphilis; not for oral or anal

specimens due to presence of nonpathogenic treponemes.

■Fluorescent antibody microscopy: use if darkfield not available and

for oral and anal specimens

■Non-treponemal serologic tests (RPR and VDRL): Inexpensive, rapid,

quantitative, screening tests, titers correlate with disease activity and

response to therapy:

➣RPR+in 80% primary, 99% secondary, 56% tertiary

➣VDRL+in 70% primary, 99% secondary, 56% tertiary

➣False positive results: IV drug use, pregnancy, autoimmune dis-

ease, immunization, infections (EBV, TB, SBE, malaria)

➣False negatives: early infection, prozone phenomenon (rare)

■Treponemal serologic tests (FTA-ABS, MHA-TP, TPHA): More sensi-

tive, expensive, confirmatory tests

➣FTA-ABS+in 85% primary, 100% secondary, 98% tertiary

➣MHA-TP+in 65% primary, 100% secondary, 95% tertiary

Other Tests

■Chest Xray: linear calcifications in ascending aorta suggestive of car-

diovascular syphilis 1/1/2001

differential diagnosis

■Primary: HSV, chancroid, lymphogranulorna venereum, fixed drug

eruption, traumatic ulcer, aphthous ulcer

■Secondary: drug reaction, pityriasis rosea, viral exanthem, tinea ver-

sicolor, acute guttate psoriasis, condyloma acuminata

management

What to Do First

■Obtain specimens for darkfield microscopy, if available

General Measures

■Test for HIV; consider testing for gonorrhea, chlamydia