8/14/2019 Syphilis Everything You Need to Know 5

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11/15/13 Syphilis - Wikipedia, the free encyclopedia

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Poster for testing of syphilis, showing

a man and a woman bowing their

heads in shame (circa1936)

Diagnosis

Syphilis is difficult to diagnose clinically early in its presentation.[8]

Confirmation is either via blood tests or direct visual inspection using

microscopy. Blood tests are more commonly used, as they are easier

to perform.[4]Diagnostic tests are, however, unable to distinguish

between the stages of the disease.[15]

Blood tests

Blood tests are divided into nontreponemal and treponemal tests.[8]

Nontreponemal tests are used initially, and include venereal disease

research laboratory (VDRL) and rapid plasma reagin tests. However,

as these tests are occasionally false positives, confirmation is required

with a treponemal test, such as treponemal pallidum particle

agglutination (TPHA) or fluorescent treponemal antibody absorption

test (FTA-Abs).[4]False positives on the nontreponemal tests canoccur with some viral infections such as varicella and measles, as well

as with lymphoma, tuberculosis, malaria, endocarditis, connective

tissue disease, and pregnancy.[7]Treponemal antibody tests usually

become positive two to five weeks after the initial infection.[8]

Neurosyphilis is diagnosed by finding high numbers of leukocytes

(predominately lymphocytes) and high protein levels in the

cerebrospinal fluid in the setting of a known syphilis infection.[4][7]

Direct testing

Dark ground microscopy of serous fluid from a chancre may be used to make an immediate diagnosis.

However, hospitals do not always have equipment or experienced staff members, whereas testing must be done

within 10 minutes of acquiring the sample. Sensitivity has been reported to be nearly 80%, thus can only be used

to confirm a diagnosis but not rule one out. Two other tests can be carried out on a sample from the chancre:

direct fluorescent antibody testing and nucleic acid amplification tests. Direct fluorescent testing uses antibodies

tagged with fluorescein, which attach to specific syphilis proteins, while nucleic acid amplification uses

techniques, such as the polymerase chain reaction, to detect the presence of specific syphilis genes. These tests

are not as time-sensitive, as they do not require living bacteria to make the diagnosis.[8]

Prevention

As of 2010, there is no vaccine effective for prevention.[5]Abstinence from intimate physical contact with an

infected person is effective at reducing the transmission of syphilis, as is the proper use of a latex condom.

Condom use, however, does not completely eliminate the risk.[14][16]Thus, the Centers for Disease Control and

Prevention recommends a long-term, mutually monogamous relationship with an uninfected partner and the

avoidance of substances such as alcohol and other drugs that increase risky sexual behavior.[14]

Congenital syphilis in the newborn can be prevented by screening mothers during early pregnancy and treatingthose who are infected.[17]The United States Preventive Services Task Force (USPSTF) strongly recommends

universal screening of all pregnant women,[18]while the World Health Organization recommends all women be

tested at their first antenatal visit and again in the third trimester.[19]If they are positive, they recommend their

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