Serological tests for syphilis may show varying results in association with HIV infection.Thus care should be taken to interpret these result

Bhat M, Dr. Ramesh

English

Cognitive Sciences ePrint Archive

 1 
Published Quarterly 
Mangalore, South India 
ISSN 0972-5997 
Volume 4, Issue 3; Jul-Sep 2005 
 
 
 
Serological Tests Of Syphilis In HIV Infection 
Author 
Ramesh Bhat M, Professor, 
Department of Skin and STD, Fr. Muller's Medical College, Mangalore–575002, INDIA 
Address For Correspondence 
Dr. Ramesh Bhat M, MD; DVD; DNB, MNAMS 
Professor, Dept. of Dermatology, Venereology & Leprosy, 
Fr. Muller's Medical College, 
Kankanady, Mangalore - 575002, India 
E-mail: rameshderma@yahoo.com 
Citation 
Bhat RM. Serological tests for syphilis in HIV infection. Online J Health Allied 
Scs.2005;3:1 
URL 
http://www.ojhas.org/issue15/2005-3-1.htm 
Open Access Archives 
http://cogprints.ecs.soton.ac.uk/view/subjects/OJHAS.html 
http://openmed.nic.in 
 
Abstract: 
Serological tests for syphilis may show varying results in association with HIV 
infection.Thus care should be taken to interpret these results. 
Key Words: Serological test, Syphilis, HIV 
 
 
 
 
 
Editorial 
OJHAS Vol 4 Issue 3, 2005-3-1: E ditorial Serological tests of syph ilis in HIV infection .  Accessed at h ttp;//www.ojh as.org/issue 15/2005-3-1.h tm 
 2 
he diagnosis of syphilis depends on clinical findings, examination of lesions for 
treponemes and on serological tests. Serological tests are divided into 
nontreponemal and treponemal tests. Non treponemal tests like VDRL, RPR, 
toluidine red unheated serum tests can be used for screening and treponemal tests 
like FTAbs assay, TPHA, ELISA etc can be used for confirmation. 
There is epidemiological synergy between HIV and other STIs including syphilis. In 
most patients with early HIV infection, the clinical features, response to treatment 
are similar to those in non-HIV infected persons. With advancing immunosuppression 
all of these may be significantly altered. 
On the one hand a significant number have false positive VDRL tests due to 
polyclonal B cell activation and on the other development of a new positive VDRL 
may be delayed in patients with new infections. FTAbs test may be negative due to 
immunodeficiency. Thus dark field examination of appropriate specimens should be 
performed in any patient in whom syphilis is suspected and even if VDRL is negative. 
In recent years the reliability of the serological tests for diagnosis of syphilis in HIV 
infected individuals has been questioned and some have discussed that false positive 
treponemal test results occur less frequently than false positive cardiolipin antigen 
tests. 
In a patient with positive serum VDRL test, neurological findings and abnormal spinal 
fluid examination should be considered to have neurosyphilis, regardless of CSF 
VDRL result. 
The ability to detect treponemal DNA by PCR may be helpful in understanding the 
pathogenesis of syphilis as well as the diagnosis of syphilis in HIV infected patients 
and in establishing adequate treatment. 
Syphilitic patients who are HIV positive are less likely to experience serologic 
improvement after recommended therapy than patients who are HIV negative. 
Therfore consideration should be given to design alternative therapeutic regimens. 
Serologic follow up of patients treated for syphilis should include quantitative 
nontreponemal tests at the end of 1,2,3 months and 3 monthly intervals thereafter. If 
the titer does not decrease by two fold dilutions in 3 months for primary syphilis or 
with 6 months for secondary syphilis. Patient need to be reevaluated for treatment 
failure or reinfection. For comparing the results same test should be performed 
before and after therapy  
  
 
 
 
 
 
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OJHAS Vol 4 Issue 3, 2005-3-1: E ditorial Serological tests of syph ilis in HIV infection .  Accessed at h ttp;//www.ojh as.org/issue 15/2005-3-1.h tm 
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References 
1. Hicks CB, Benson PM, Lupton GP, Tramont EC. Seronegative secondary 
syphilis in a patient infected with the human immunodeficiency virus (HIV) 
with Kaposi sarcoma. A diagnostic dilemma. Ann Intern Med 1987;107:492-
497 
2. Rusnak JM, Butzin C, McGlasson D, Blatt SP. False positive rapid plasma reagin 
tests in human immunodeficiency virus infection and relationship to anti-
cardiolipin antibody and serum immunoglobulin levels. J Infect Dis 
1994;169:1356-1359 
3. MacLean SK, Bordon J. False positive rapid reagin tests and anticardiolipin 
antibodies. J Infect Dis 1995;172:905-906 
OJHAS Vol 4 Issue 3, 2005-3-1: E ditorial Serological tests of syph ilis in HIV infection .  Accessed at h ttp;//www.ojh as.org/issue 15/2005-3-1.h tm 


False positive rapid plasma reagin tests in human immunodeficiency virus infection and relationship to anticardiolipin antibody and serum immunoglobulin levels.

Serological Tests Of Syphilis In HIV Infection

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