asmi
Forum Hero
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What is the investigation of choiice for :
*Chancre
*Congenital syphilis
*neurosyphilis
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| anne
Forum Elite
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chancre--dark-field microscopy of a specimen from chancre.
neurosyphilis---VDRL test,and RPR test on CSF(showing inc in anticardiolipin aantibodies)
congenital syphilis--- :?:
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| Colombia
Forum Guru
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chancre=Darkfield
Neurosyphilis =VDRL
congenital =VDRL
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| asmi
Forum Hero
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correct.
in congenital and neuro syphilis .....VDRL,FTABS
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| Malaysian
Forum Guru
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why is it in tertiary syphilis and congenital syphilis is the VDRL being performed and not the more specific test?
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| mdwannabe
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In primary syphilis RPR is positive approximately 60% of the time. The test's usefulness increases with later stages of syphilis where it may be positive 70-90% of the time. In the final stages of syphilis, this test is usually positive in only 60% of cases.
So VDRL is better for tirtiarty syph.
The rest of SPECIFIC AB are ususally immobilized in lattice in vessels or cleared, making the SPECIFIC tests negative.
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| bactitech
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Most labs screen with RPR first, unless you would have a chit chat with the Serology department specifically asking for a VDRL. Most labs only use VDRL for CSF. If RPR is positive, then FTA-ABS is used as the ultimate confirmatory. I'm sorry I can't speak to percentages as it's been too long since I've actually done these tests.
As far as darkfield exam, I think I explained in another similar thread that many labs are unable to perform this. You would need to check with your local micro lab's director before you send this up, as there are specific specimen requirements (which I unfortunately am not familiar with). Our Ph.D's were the only ones messing around with these usually, and it's been many years since I've seen a request. That being said, in an area where there is more syphilis the labs may offer it more routinely.
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm48... (information on congenital syphilis)
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5331a4... (2004 data)
http://www.cdc.gov/nchstp/dstd/SyphilisInfo.htm
(lots of general data)
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Clinical Microbiology since 1974
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