|
KMID : 0360919620050070090
|
|
Journal of the Korean Medical Association
1962 Volume.5 No. 7 p.90 ~ p.90
|
|
|
Syphilis Serology
|
|
Hessen, Donald K.
|
|
|
Abstract
|
|
|
It would seem that a periodic review of the proper interpretation of serologic reactions as tools in the diagnosis or evaluation of syphilis is necessary. The mandatory requiring of these tests by Preventive Medicine and Public Health agencies tends to cause a forgetfulness and consequently often a clinical misinterpretation of the result.
It must be remembered that these reactions are based upon the detection,of antibodies or antibody.like substances formed by the patient after infection. Consequently serological reactions will not become positive (reactive) until 14. to 28 days after the beginning of invasion by the spirochete. Thus a negative reaction in no way eliminates the possibility of syphilitic disease. Rather it tells us that no syphilis had been contracted as of a date 2 to 4 weeks prior to the test. On the opposite veiw, the positive serology is not necessarily due to syphilitic infection. -Certain related organisms i. e. the agents of pinta, yaws, etc. as well as certain nonrelated febrile stimulating infections such as tuberculosis, leprosy, typhoid fever, recent immunizations, etc. may give -false positive results. Thus very astute clinical judgement must be utilized in the proper interpretation ,of a serological result.
The most commonly utilized serological tests, particularly in the Western World, today are the cardiolipin microflocculation test, cardiolipin complement fixation(Wasserman-Koliser) test and the Treponema pallidum immobilization (TPI) test. Each has its own advantages and disadvantages which must be considered when interpretations are made. The ,Cardiolipin microflocculation test (CM) is a rapid and cheap test. It is relatively easy to reproduce results in the hands of several different workers. It is ultrasensitive and will detect syphilitic type of antibodies-much earlier than most other tests. However, due to its supersensitivity many false positive reactions are manifested. It also remains positive for a longer time following adequate treatment than do the other tests.
The Cardiolipin complement fixation test is a more lengthy and expensive test. It requires a minimum of 48 hours to perform. It utilizes multiple and complex ingredients. Therefore, it requires greater technical ability and more elaborate controls than other serologic tests. It is much less sensitive than the microflocculation test (CM). Therefore, it gives fewer false positive results and becomes negative much
sooner after adequate treatment. However, due to this lowered sensitivity it will detect new infections at a date somewhat later than the cardiolipin microflocculation test (CI ND.
The treponema pallidum immobilization test (TPI) is the most sensitive and at the same time most specific of the tests. However, due to the extremely high cost of performance and the technical difficulties involved, it is usually reserved for those very special cases where clinical signs, history and serologic results -present some confusion.
Since all of these tests will remain positive for some period of time after treatment, it is certainly advisable if not mandatory that a quatitative measurement of antibody be made prior to treatment and again approximately 10 days after completion of the treatment. Successful treatment will be indicated by a reduction in antibody titre.
There are many other tests i. e. Hinton, Mazzini, Eagle, Kline, Kahn, etc. The test all present the same problems of interpretation as the three cited tests.
|
|
|
KEYWORD
|
|
|
|
|
|
FullTexts / Linksout information
|
|
|
|
|
|
Listed journal information
|
|
|
|
|