Dark ground microscopy and treponemal serological tests in the diagnosis of early syphilis

Objectives: To evaluate the use of dark ground microscopy (DGM) and treponemal serological tests in the diagnosis of primary (PS) and secondary (SS) syphilis. Methods: A retrospective case note review of patients with early syphilis who attended our department between January 2001 and December 2002....

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Veröffentlicht in:Sexually transmitted infections 2004-10, Vol.80 (5), p.411-414
Hauptverfasser: Wheeler, H L, Agarwal, S, Goh, B T
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Agarwal, S
Goh, B T
description Objectives: To evaluate the use of dark ground microscopy (DGM) and treponemal serological tests in the diagnosis of primary (PS) and secondary (SS) syphilis. Methods: A retrospective case note review of patients with early syphilis who attended our department between January 2001 and December 2002. Data were collected on demographics, results of treponemal serology and DGM. Results: 50 individuals had PS and 36 individuals had SS. DGM was performed in 31/50 (62%) of PS cases and this was positive in 97%. In 17 (34%) cases of PS, treponemal EIA was negative initially. DGM was performed on 13 of these, all of which were positive. Therefore, EIA had a sensitivity of 57% when compared to DGM. In 27 patients where EIA-IgM was performed, this was positive in 22 (81%), of which 12 were EIA negative on initial screening. All SS cases had positive EIA. DGM was performed in 19/36 (52%) of SS cases and was positive in 16/19—that is, a sensitivity of 84% when compared to EIA. The major reason why DGM was not performed in the cases of PS was that herpes was the presumed diagnosis and in SS the rash was attributed to other causes. Conclusions: DGM is a rapid and sensitive test while EIA takes time for results and is less sensitive in PS. EIA-IgM is a useful adjunct in PS. DGM allows immediate diagnosis, treatment, and partner notification preventing further transmission. Genitourinary medicine clinics should have trained staff to perform DGM on all anogenital ulcers and suspected syphilitic lesions.
doi_str_mv 10.1136/sti.2003.008821
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Methods: A retrospective case note review of patients with early syphilis who attended our department between January 2001 and December 2002. Data were collected on demographics, results of treponemal serology and DGM. Results: 50 individuals had PS and 36 individuals had SS. DGM was performed in 31/50 (62%) of PS cases and this was positive in 97%. In 17 (34%) cases of PS, treponemal EIA was negative initially. DGM was performed on 13 of these, all of which were positive. Therefore, EIA had a sensitivity of 57% when compared to DGM. In 27 patients where EIA-IgM was performed, this was positive in 22 (81%), of which 12 were EIA negative on initial screening. All SS cases had positive EIA. DGM was performed in 19/36 (52%) of SS cases and was positive in 16/19—that is, a sensitivity of 84% when compared to EIA. The major reason why DGM was not performed in the cases of PS was that herpes was the presumed diagnosis and in SS the rash was attributed to other causes. Conclusions: DGM is a rapid and sensitive test while EIA takes time for results and is less sensitive in PS. EIA-IgM is a useful adjunct in PS. DGM allows immediate diagnosis, treatment, and partner notification preventing further transmission. Genitourinary medicine clinics should have trained staff to perform DGM on all anogenital ulcers and suspected syphilitic lesions.</description><identifier>ISSN: 1368-4973</identifier><identifier>EISSN: 1472-3263</identifier><identifier>DOI: 10.1136/sti.2003.008821</identifier><identifier>PMID: 15459413</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd</publisher><subject>Bacterial diseases ; Bacterial diseases of the genital system ; Biological and medical sciences ; Cohort Studies ; dark ground microscopy ; DFA-Tp ; DGM ; direct fluorescent antibody ; EIA ; enzyme immunoassay ; Female ; General aspects ; Human bacterial diseases ; Human infectious diseases. Experimental studies and models ; Humans ; Infections ; Infectious diseases ; Laboratories ; Male ; Medical diagnosis ; Medical sciences ; Medicine ; Microscopy ; Microscopy - methods ; Microscopy - standards ; Original ; Patients ; PCR ; polymerase chain reaction ; primary syphilis ; rapid plasma reagin ; Retrospective Studies ; RPR ; secondary syphilis ; Sensitivity and Specificity ; Syphilis ; Syphilis - diagnosis ; Syphilis Serodiagnosis - methods ; Syphilis Serodiagnosis - standards ; Treponema pallidum - isolation &amp; purification ; treponemal serological tests</subject><ispartof>Sexually transmitted infections, 2004-10, Vol.80 (5), p.411-414</ispartof><rights>Copyright 2004 Sexually Transmitted Infections</rights><rights>2005 INIST-CNRS</rights><rights>Copyright: 2004 Copyright 2004 Sexually Transmitted Infections</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b551t-c13def88978683c06c73cd136f5070608b359151f54474a698b50341aaa1a4253</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1744899/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1744899/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27903,27904,53769,53771</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=16206270$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15459413$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wheeler, H L</creatorcontrib><creatorcontrib>Agarwal, S</creatorcontrib><creatorcontrib>Goh, B T</creatorcontrib><title>Dark ground microscopy and treponemal serological tests in the diagnosis of early syphilis</title><title>Sexually transmitted infections</title><addtitle>Sex Transm Infect</addtitle><description>Objectives: To evaluate the use of dark ground microscopy (DGM) and treponemal serological tests in the diagnosis of primary (PS) and secondary (SS) syphilis. Methods: A retrospective case note review of patients with early syphilis who attended our department between January 2001 and December 2002. Data were collected on demographics, results of treponemal serology and DGM. Results: 50 individuals had PS and 36 individuals had SS. DGM was performed in 31/50 (62%) of PS cases and this was positive in 97%. In 17 (34%) cases of PS, treponemal EIA was negative initially. DGM was performed on 13 of these, all of which were positive. Therefore, EIA had a sensitivity of 57% when compared to DGM. In 27 patients where EIA-IgM was performed, this was positive in 22 (81%), of which 12 were EIA negative on initial screening. All SS cases had positive EIA. DGM was performed in 19/36 (52%) of SS cases and was positive in 16/19—that is, a sensitivity of 84% when compared to EIA. The major reason why DGM was not performed in the cases of PS was that herpes was the presumed diagnosis and in SS the rash was attributed to other causes. Conclusions: DGM is a rapid and sensitive test while EIA takes time for results and is less sensitive in PS. EIA-IgM is a useful adjunct in PS. DGM allows immediate diagnosis, treatment, and partner notification preventing further transmission. Genitourinary medicine clinics should have trained staff to perform DGM on all anogenital ulcers and suspected syphilitic lesions.</description><subject>Bacterial diseases</subject><subject>Bacterial diseases of the genital system</subject><subject>Biological and medical sciences</subject><subject>Cohort Studies</subject><subject>dark ground microscopy</subject><subject>DFA-Tp</subject><subject>DGM</subject><subject>direct fluorescent antibody</subject><subject>EIA</subject><subject>enzyme immunoassay</subject><subject>Female</subject><subject>General aspects</subject><subject>Human bacterial diseases</subject><subject>Human infectious diseases. 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Conclusions: DGM is a rapid and sensitive test while EIA takes time for results and is less sensitive in PS. EIA-IgM is a useful adjunct in PS. DGM allows immediate diagnosis, treatment, and partner notification preventing further transmission. Genitourinary medicine clinics should have trained staff to perform DGM on all anogenital ulcers and suspected syphilitic lesions.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd</pub><pmid>15459413</pmid><doi>10.1136/sti.2003.008821</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record>
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ispartof Sexually transmitted infections, 2004-10, Vol.80 (5), p.411-414
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subjects Bacterial diseases
Bacterial diseases of the genital system
Biological and medical sciences
Cohort Studies
dark ground microscopy
DFA-Tp
DGM
direct fluorescent antibody
EIA
enzyme immunoassay
Female
General aspects
Human bacterial diseases
Human infectious diseases. Experimental studies and models
Humans
Infections
Infectious diseases
Laboratories
Male
Medical diagnosis
Medical sciences
Medicine
Microscopy
Microscopy - methods
Microscopy - standards
Original
Patients
PCR
polymerase chain reaction
primary syphilis
rapid plasma reagin
Retrospective Studies
RPR
secondary syphilis
Sensitivity and Specificity
Syphilis
Syphilis - diagnosis
Syphilis Serodiagnosis - methods
Syphilis Serodiagnosis - standards
Treponema pallidum - isolation & purification
treponemal serological tests
title Dark ground microscopy and treponemal serological tests in the diagnosis of early syphilis
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