Diagnosis of Syphilis
Diagnostic Test list for Syphilis:
The list of medical tests
mentioned in various sources as
used in the diagnosis of Syphilis
includes:
- Swab of chancre - in primary and secondary syphilis phases
- Swab/scraping test
- Syphilis blood tests
- VDRL (Venereal Disease Research Laboratory) test
- RPR (rapid plasma reagin) test
- Syphilis antibody tests
- Lumbar puncture (spinal tap) - to test CSF for syphilis exposure
- CSF syphilis tests
- Repetition of blood tests - some blood tests take up to 3 months to be positive after infection.
Syphilis Diagnosis: Book Excerpts
Tests and diagnosis discussion for Syphilis:
There are three ways to diagnose syphilis: a doctor's
recognition of its signs and symptoms; microscopic identification
of syphilis bacteria; and blood tests. The doctor usually uses
these approaches together to detect syphilis and decide upon the
stage of infection.
To diagnose syphilis by identifying the bacteria, the doctor
takes a scraping from the surface of the ulcer or chancre, and
examines it under a special "darkfield" microscope to detect the
organism itself. Blood tests also provide evidence of infection,
although they may give false- negative results (not show signs of
infection despite its presence) for up to three months after
infection. False-positive tests also can occur; therefore, two
blood tests are usually used. Interpretation of blood tests for
syphilis can be difficult, and repeated tests are sometimes
necessary to confirm the diagnosis.
The blood-screening tests most often used to detect evidence of
syphilis are the VDRL (Venereal Disease Research Laboratory) test
and the RPR (rapid plasma reagin) test. The false-positive results
(showing signs of infection when it is not present) occur in
people with autoimmune disorders, certain viral infections, and
other conditions.
Therefore, a doctor will administer a confirmatory blood test
when the initial test is positive. These tests include the
fluorescent treponemal antibody-absorption (FTA-ABS) test that can
accurately detect 70 to 90 percent of cases. Another specific test
is the T. pallidum hemagglutination assay (TPHA). These
tests detect syphilis antibodies (proteins made by a person's
immune system to fight infection). They are not useful for
diagnosing a new case of syphilis in patients who have had the
disease previously because once antibodies are formed, they remain
in the body for many years. These antibodies, however, do not
protect against a new syphilis infection. In some patients with
syphilis (especially in the latent or late stages), a lumbar
puncture (spinal tap) must be done to check for infection of the
nervous system.
Treatment
Syphilis usually is treated with penicillin, administered by
injection. Other antibiotics can be used for patients allergic to
penicillin. A person usually can no longer transmit syphilis 24
hours after beginning therapy. Some people, however, do not
respond to the usual doses of penicillin. Therefore, it is
important that people being treated for syphilis have periodic
blood tests to check that the infectious agent has been completely
destroyed. Persons with neurosyphilis may need to be retested for
up to two years after treatment. In all stages of syphilis, proper
treatment will cure the disease, but in late syphilis, damage
already done to body organs cannot be reversed.
Effects of Syphilis in Pregnant
Women
It is likely that an untreated pregnant woman with active
syphilis will pass the infection to her unborn child. About 25
percent of these pregnancies result in stillbirth or neonatal
death. Between 40 to 70 percent of such pregnancies will yield a
syphilis-infected infant.
Some infants with congenital syphilis may have symptoms at
birth, but most develop symptoms between two weeks and three
months later. These symptoms may include skin sores, rashes,
fever, weakened or hoarse crying sounds, swollen liver and spleen,
yellowish skin (jaundice), anemia, and various deformities. Care
must be taken in handling an infant with congenital syphilis
because the moist sores are infectious.
Rarely, the symptoms of syphilis go undetected in infants. As
infected infants become older children and teenagers, they may
develop the symptoms of late-stage syphilis including damage to
their bones, teeth, eyes, ears, and brain.
Prevention
The open sores of syphilis may be visible and infectious during
the active stages of infection. Any contact with these infectious
sores and other infected tissues and body fluids must be avoided
to prevent spread of the disease. As with many other STDs, methods
of prevention include using condoms during sexual intercourse.
Screening and treatment of infected individuals, or secondary
prevention, is one of the few options for preventing the advance
stages of the disease. Testing and treatment early in pregnancy is
the best way to prevent syphilis in infants and should be a
routine part of prenatal care.
Research
Developing better ways to diagnose and treat syphilis is an
important research goal of scientists supported by the National
Institute of Allergy and Infectious Diseases (NIAID). New tests
are being developed that may provide better ways to diagnose
syphilis and define the stage of infection.
In an effort to stem the spread of syphilis, scientists are
conducting research on a vaccine. Molecular biologists are
learning more about the various surface components of the syphilis
bacterium that stimulate the immune system to respond to the
invading organism. This knowledge will pave the way for
development of an effective vaccine that can ultimately prevent
this STD.
A high priority for researchers is development of a diagnostic
test that does not require a blood sample. Saliva and urine are
being evaluated to see whether they would work as well as blood.
Researchers also are trying to develop other diagnostic tests for
detecting infection in babies.
Another high research priority is the development of a safe,
effective, single-dose oral antibiotic therapy for syphilis. Many
patients do not like getting an injection for treatment, and about
10 percent of the general population is allergic to penicillin.
Recently, the genome of this organism has been sequenced. The
sequence represents an encyclopedia of information about the
organism. Clues as to how to diagnose, treat, and vaccinate
against syphilis have been identified already and are fueling
intensive research efforts in this ancient but intractable
disease.
(Source: excerpt from
Syphilis, NIAID Fact Sheet: NIAID)
Diagnosis of Syphilis: medical news summaries:
The following medical news items
are relevant to diagnosis and misdiagnosis issues for Syphilis:
Diagnostic Tests for Syphilis: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about diagnostis of Syphilis.
Genital lesions in the male:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin by asking the patient when he first noticed the lesion. Did it erupt after he began taking a new drug or after a trip out of the country? Has he had similar lesions before? If so, did he get medical treatment for them? Find out if he has been treating the lesion himself. If so, how? Does the lesion itch? If so, is the itching constant or does it bother him only at night? Note whether the lesion is painful. Ask for a description of any drainage from the lesions. Next, take a complete sexual history, noting the frequency of relations, number of sexual partners, and pattern of condom use.
Before you examine the patient, observe his clothing. Do his pants fit properly? Tight pants or underwear, especially those made of nonabsorbent fabrics, can promote the growth of bacteria and fungi. Examine the entire skin surface, noting the location, size, color, and pattern of the lesions. Do genital lesions resemble lesions on other parts of the body? Palpate for nodules, masses, and tenderness. Also, look for bleeding, edema, or signs of infection, such as purulent drainage or erythema. Finally, take the patient’s vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Syphilis:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
CONFIRMING DIAGNOSIS Identifying T. pallidum from a lesion on dark-field examination confirms the diagnosis of syphilis. This method is most effective when moist lesions are present, as in primary, secondary, and prenatal syphilis. (See Treponema pallidum.)
The fluorescent treponemal antibody-absorption test identifies antigens of T. pallidum in tissue, ocular fluid, cerebrospinal fluid (CSF), tracheobronchial secretions, and exudates from lesions. This is the most sensitive test available for detecting syphilis in all stages. Once reactive, it remains so permanently.
Other appropriate procedures include the following:
❑ Venereal Disease Research Laboratory (VDRL) slide test and rapid plasma reagin test (RPR) detect nonspecific antibodies. Both tests, if positive, become reactive within 1 to 2 weeks after the primary lesion appears or 4 to 5 weeks after the infection begins.
❑ CSF examination identifies neurosyphilis when the total protein level is above 40 mg/dl, the VDRL slide test is reactive, and the cell count exceeds five mononuclear cells/µl.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Genital lesions in the male:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin by asking the patient when he first noticed the lesion. Did it erupt after he began taking a new drug or after a trip out of the country? Has he had similar lesions before? If so, did he get medical treatment for them? Find out if he has been treating the lesion himself. If so, how? Does the lesion itch? If so, is the itching constant or does it bother him only at night? Note whether the lesion is painful. Ask for a description of any drainage from the lesion. Next, take a complete sexual history, noting the frequency of relations, the number of sexual partners, and the pattern of condom use.
Before you examine the patient, observe his clothing. Do his pants fit properly? Tight pants or underwear, especially those made of nonabsorbent fabrics, can promote the growth of bacteria and fungi. Examine the entire skin surface, noting the location, size, color, and pattern of the lesions. Do genital lesions resemble lesions on other parts of the body? Palpate for nodules, masses, and tenderness. Also, look for bleeding, edema, or signs of infection, such as purulent drainage or erythema. Finally, take the patient’s vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Syphilis:
Diagnosis
(Handbook of Diseases)
Identifying T. pallidum from a lesion on a dark-field examination provides immediate diagnosis of syphilis. This method is most effective when moist lesions are present, as in primary, secondary, and prenatal syphilis.
The fluorescent treponemal antibody-absorption test identifies antigens of T. pallidum tissue, ocular fluid, cerebrospinal fluid (CSF), tracheobronchial secretions, and exudates from lesions. This is the most sensitive test available for detecting syphilis in all stages. After it becomes reactive, it remains so permanently.
Other appropriate procedures include the following:
❑ Venereal Disease Research Laboratory (VDRL) slide test and rapid plasma reagin test detect nonspecific antibodies. Both tests, if positive, become reactive within 1 to 2 weeks after the primary lesion appears or 4 to 5 weeks after the infection begins.
❑ CSF examination identifies neurosyphilis when the total protein level is above 40 mg/100 ml, VDRL slide test is reactive, and CSF cell count exceeds five mononuclear cells/µl.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Genital lesions in the male:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin by asking the patient when he first noticed the lesion. Did it erupt after he began taking a new drug or after a trip out of the country? Has he had similar lesions before? If so, did he get medical treatment for them? Find out if he has been treating the lesion himself. If so, how? Does the lesion itch? If so, is the itching constant or does it bother him only at night? Note whether the lesion is painful. Ask for a description of any drainage from the lesions. Next, take a complete sexual history, noting the frequency of relations, number of sexual partners, and pattern of condom use.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Genital lesions, male:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin by asking the patient when he first noticed the lesion. Did it erupt after he began taking a new drug or after a trip out of the country? Has he had similar lesions before? If so, did he get medical treatment for them? Find out if he has been treating the lesion himself. If so, how? Does the lesion itch? If so, is the itching constant or does it bother him only at night? Note whether the lesion is painful. Ask for a description of any drainage from the lesion. Next, take a complete sexual history, noting the frequency of relations, number of sexual partners, and pattern of condom use.
Before you examine the patient, observe his clothing. Do his pants fit properly? Tight pants or underwear, especially those made of nonabsorbent fabrics, can promote the growth of bacteria and fungi. Examine the entire skin surface, noting the location, size, color, and pattern of the lesions. Do genital lesions resemble lesions on other parts of the body? Palpate for nodules, masses, and tenderness. Also, look for bleeding, edema, or signs of infection, such as purulent drainage or erythema. Finally, take the patient's vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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