Abstract
The Venereal Disease Research Laboratory (VDRL) test has long been considered the best serological test for the diagnosis of neurosyphilis. The goal of this study was to find out if the Rapid Plasma Reagin (RPR) could be an alternative to the VDRL. Cerebrospinal fluid (CSF) and sera samples from patients in the following stages of syphilis were tested: 8 had symptomatic and 16 asymptomatic neurosyphilis, 4 were in the primary stage, 6 had secondary syphilis, and 92 were in the latent stage. We have also studied 61 samples from individuals with treated syphilis and 126 with other neurological diseases than neurosyphilis. All the CSF samples were studied with both RPR and VDRL tests. RPR and VDRL test results were mostly concordant. The specificity of these tests for current neurosyphilis was 99% for the VDRL and 99.3% for the RPR, whereas the sensitivity was 70.8 and 75%, respectively, for the VDRL and RPR. In view of these results it seems to us that the RPR could be an alternative to the VDRL in the diagnosis of neurosyphilis. J. Clin. Lab. Anal. 22:257–261, 2008. © 2008 Wiley‐Liss, Inc.
Keywords: neurosyphilis, RPR, VDRL, CSF
REFERENCES
- 1. Larsen SA, Hambie EA. 1985. Cerebrospinal fluid serologic test for syphilis: Treponemal and nontreponemal tests In: Morisset R, Kurstak E, editors. Advances in Sexually Transmitted Diseases. Ultrecht, The Netherlands: VNW Science Press; p 157–162. [Google Scholar]
- 2. Chung KY, Lee MG, Lee JB. Detection of Treponema pallidum by polymerase chain reaction in the cerebrospinal fluid of syphilis patients. Yonsei Med J 1994;35:190–197. [DOI] [PubMed] [Google Scholar]
- 3. Hay PE, Clark JR, Taylor‐Robinson D, Goldmeier D. Detection of treponemal DNA in the CSF of patients with syphilis and HIV infection using the polymerase chart reaction. Genitourin Med 1990;66:428–432. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Marra CM, Maxwell CL, Smith SL, et al. Cerebrospinal fluid abnormalities in patients with syphilis: Association with clinical and laboratory features. J Infect Dis 2004;189:369–376. [DOI] [PubMed] [Google Scholar]
- 5. Centers for Disease Control and Prevention . 2006. Guidelines for treatment of sexually transmitted diseases. Morbidity and Mortality Weekly Report, Vol. 55(RR11), 1 p. [PubMed]
- 6. Goh BT, Van Voorst Vader PC. European Branch of the International Union Against Sexually Transmitted Infection and the European Office of the World Health Organization. European guideline for the management of syphilis. Int J STD AIDS 2001;12:14–26. [DOI] [PubMed] [Google Scholar]
- 7. Davis LE, Sperry S. The CSF‐FTA test and significance of blood contamination. Ann Neurol 1979;6:68–69. [DOI] [PubMed] [Google Scholar]
- 8. Davis LE, Schmitt JW. Clinical significance of cerebrospinal fluid tests for neurosyphilis. Ann Neurol 1989;5:50–55. [DOI] [PubMed] [Google Scholar]
- 9. Izzat NN, Bartruff JK, Glicksman JM, Holder WR, Knox JM. Validity of the VDRL test on cerebrospinal fluid contaminated by blood. Br J Vener Dis 1971;47:162–164. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10. Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin Microbiol Rev 1995;8:1–21. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11. Marra CM. Neurosyphilis. Curr Neurol Neurosci Rep 2004;4:435–440. [DOI] [PubMed] [Google Scholar]
- 12. Lukehart SA, Hook EW, Baker‐Zander SA, Collier AC, Critchlow CW, Handsfield HH. Invasion of the central nervous system by Treponema pallidum: Implications for diagnosis and treatment. Ann Intern Med 1988;109:855–862. [DOI] [PubMed] [Google Scholar]
- 13. Burke JM, Schaberg DR. Neurosyphilis in the antibiotic era. Neurology 1985;5:1368–1371. [DOI] [PubMed] [Google Scholar]
- 14. Conde‐Sendín MA, Hérnandez‐Fleta JL, Cádenes‐Santana MA, Amela‐Peris R. Neurosífilis: formas de presentación y manejo clínico. Rev Neurol 2002;35:380–386. [PubMed] [Google Scholar]
- 15. Hooshmand H, Escobar MR, Kopf SW. Neurosyphilis. A study of 241 patients. J Am Med Assoc 1972;19:726–728. [DOI] [PubMed] [Google Scholar]
- 16. Jaffe HW, Kabins SA. Examination of cerebrospinal fluid in patients with syphilis. Rev Infect Dis 1982;4:S842–S847. [Google Scholar]
- 17. Sparling PF. Diagnosis and treatment of syphilis. N Engl J Med 1971;284:642–653. [DOI] [PubMed] [Google Scholar]
- 18. Jaffe HW, Larsen SA, Peters M, Jove DF, Lopez B, Schroeter AL. Tests for treponemal antibody in CSF. Arch Intern Med 1978;138:252–255. [PubMed] [Google Scholar]
- 19. Marra CM, Critchlow CW, Hook EW, Collier AC, Lukehart S. Cerebrospinal fluid treponemal antibodies in untreated early syphilis. Arch Neurol 1995;52:68–72. [DOI] [PubMed] [Google Scholar]
- 20. Joyanes P, Borobio VM, Árquez JM, Perea E. The association of false‐positive Rapid Plasma Reagin results and HIV infection. Sex Transm Dis 1998;25:569–571. [DOI] [PubMed] [Google Scholar]
- 21. Rompalo AM, Cannon RO, Quinn TC, Hook EW III. Association of biologic false‐positive reactions for syphilis with human immunodeficiency virus infection. J Infect Dis 1992;165:1124–1126. [DOI] [PubMed] [Google Scholar]
- 22. Rusnak JM, Butzin C, MacGlason D, Blatt SP. False positive rapid plasma reagin test in human immunodeficiency virus infection and relationship to anticardiolipin antibody and serum immunoglobulin levels. J Infect Dis 1994;169:1356–1359. [DOI] [PubMed] [Google Scholar]