Serological tests in venereal syphilis

Apart from identification of the causative microorganism, serological blood testing is still the principal aid in the diagnosis of venereal syphilis. In latent syphilis it is in fact the only diagnostic aid. In the diagnosis of late symptomatic syphilis, additional organ-specific diagnostic procedures are indispensable. Interpretation of the results of serological syphilis tests often poses problems in actual practice. Apart from possibly inadequate knowledge of the natural history of the disease and the course of serological syphilis tests, this may be due to the fact that a fairly large number of different tests are in use in The Netherlands. Often, moreover, a single laboratory result is expected to give a definite diagnosis

Atypical Primary Syphilitic Lesions on the Penis

An increase in number of patients with an atypical clinical picture of syphilitic primary lesions on the penis is mentioned in the literature. The figures generally agree with the findings of 87 male patients with primary syphilis examined at the Department for Skin and Venereal Diseases of the University Hospital Rotterdam-Dijkzigt. Some possible reasons for the occurrence of atypical primary syphilis are mentioned. In contrast with some other authors, in our series we could not find arguments in favour of the hypothesis that previously received local or systemic treatment increased the rate of atypical primary syphilis.</jats:p

Value of a DNA probe assay (Gen-Probe) compared with that of culture for diagnosis of gonococcal infection

The Gen-Probe PACE 2 system for Neisseria gonorrhoeae (GP), which uses a chemiluminescently labeled DNA probe, was compared with conventional culture as the method of reference. A total of 1,750 specimens were collected from 496 females and 623 males visiting the outpatient clinic of the Sexually Transmitted Diseases Department of the Westeinde Hospital, The Hague, The Netherlands, during the year 1991. The prevalences of gonorrhea culture-positive men and women were 14.9 and 7.7%, respectively. The overall positive rate was 8.7%. Sensitivity, specificity, and positive and negative predictive values of GP were 97.1, 99.1, 90.6, and 99.8%, respectively. A total of 12 of 13 patients with positive GP results and negative cultures may have had a gonococcal infection, a conclusion based on clinical symptoms, positive methylene blue smears, and high relative light unit ratios. The DNA probe test can be useful as a suitable screening and diagnostic test for gonorrheal infection in men and women. An advantage of using this DNA probe technique is that simultaneous testing for Chlamydia trachomatis of the same specimen is possible. We also examined whether (all) rRNA had disappeared after adequate treatment for gonococcal and/or chlamydial infection in 30 patients. None of those positive patients showed a positive result in the DNA probe assay after treatment.</jats:p

Solitary Papular Lesions on the Penis in Insufficiently Treated early Syphilis

Two cases of insufficiently treated early syphilis with solitary papular lesions on the penis are described. There seems to be a close resemblance between these cases and descriptions from the Salvarsan era concerning the occurrence of solitary papules located on or near the place of the healed primary syphilitic lesion, after insufficient treatment with Salvarsan. Problems in diagnosing these cases are discussed.</jats:p