Reactive Fluorescent Treponemal Antibody Absorption Research Articles

Progressive Visual and Hearing Loss Secondary to Neurosyphilis

There is a rising incidence of syphilis in economically advanced countries. Early diagnosis can spare the patient devastating vision and hearing loss, as well as other significant morbidity. Ocular presentations of neurosyphilis are varied and numerous, requiring syphilis to be considered in many clinical situations, even if a negative medical history is reported. Features of Argyll Robertson pupils, however, are virtually pathognomonic of syphilis; therefore, careful pupil testing can be the key to making a correct and timely diagnosis. A 51-year-old woman with a history of unexplained hearing loss presented for a third opinion for progressive vision loss OU, which was previously labeled as functional loss. A review of records indicated significant worsening of visual acuity and visual fields over 6 months, with minimal remaining visual function. She exhibited features of optic neuropathy as well as 2 mm miotic pupils, with evident light-near dissociation bilaterally. Evaluation showed a reactive fluorescent treponemal antibody absorption and rapid plasma reagin (1:8 titer) and positive cerebral spinal fluid venereal disease research laboratory test. A diagnosis of neurosyphilis was made, and a 2-week course of intravenous penicillin treatment was completed. Despite treatment, her vision decreased to no light perception OU owing to the advanced course of the disease at the time of treatment. Neurosyphilis can occur at any stage of infection and needs to be considered in the differential diagnosis for many visual and ocular problems, especially in the setting of other systemic signs and symptoms. In this case, the combination of light-near dissociation and optic neuropathy with hearing loss was instrumental in dismissing the past diagnosis of functional vision loss and in pursuing the diagnosis of neurosyphilis. A timely diagnosis of neurosyphilis needs to be made to prevent devastating vision loss as seen in this case.

Congenital syphilis and fluorescent treponemal antibody test reactivity after the age of 1 year.

Many believe that a persistently reactive fluorescent treponemal antibody absorption (FTA-ABS) is manifested with congenital syphilis after the age of 1 year, that it is useful in the retrospective diagnosis of children with congenital syphilis, and that it can be used to confirm other treponemal tests. To determine whether a reactive FTA-ABS after the age of 12 months is indicative of congenital syphilis. Prospective outpatient follow-up evaluation until at least the age of 12 months was conducted for 194 babies born to mothers with reactive syphilis serology at delivery, and for two additional children with congenital syphilis diagnosed when they were younger than 1 year (total, 196 children). In the study group, 54 children had reactive FTA-ABS (reactors) until the age of at least 12 months or more, and 142 children had nonreactive FTA-ABS (nonreactors) at the age of 12 months or more. Of the 54 reactors, 17 (31%) had evidence of congenital syphilis at birth, whereas evidence of congenital syphilis was seen in 14 of the 142 (10%) nonreactors (P = 0.0002). At 15 months, nonreactive FTA-ABS developed in six reactors, and eventually in 15 of 44 reactors (34%) tested. A reactive FTA-ABS may be seen at 12 months in children with and without evidence of congenital syphilis at birth. Not all children with congenital syphilis will manifest reactive FTA-ABS at 12 months, and FTA-ABS reactivity wanes with time.

Sexually transmitted infections in female sex workers: reduced by condom use but not by a limited periodic examination program.

The sexually transmitted diseases (STD) control program for female sex workers (FSW) in Lima, Peru, provided periodic serological tests for syphilis and cervical smears for gonococci, but not medication for STD or condoms. To assess program effectiveness. We assessed prevalence of current STD and serum antibody to STD pathogens in FSW in relation to program participation and to condom use. Program participation was not associated with significantly reduced rates of current gonococcal or chlamydial infections or Venereal Disease Research Laboratory (VDRL) titers > or =4 with reactive fluorescent treponemal antibody absorption (FTA-ABS). However, regardless of control program participation, consistent condom use was associated with reduced prevalence of gonorrhea, and with significantly reduced seroreactivity for FTA-ABS, C. trachomatis, anti-hepatitis B core (HBc), and anti-human T-lymphotropic virus type I. Anti-HBc was associated with years of receiving penicillin injections for syphilis prophylaxis. The scope, quality, and efficacy of STD control programs must be technically appropriate, well managed, and adequately financed. The safety of marginal programs warrants scrutiny.

Syphilitic uveitis in human immunodeficiency virus-infected patients.

To document the incidence and clinical features of syphilitic uveitis in patients coinfected with human immunodeficiency virus (HIV). Retrospective chart review. Single tertiary uveitis referral center. The charts of HIV-infected patients with uveitis and a reactive fluorescent treponemal antibody absorption test seen between November 1983 and June 1995 were reviewed. Syphilis was the most common bacterial cause of uveitis in this group. Thirteen patients (0.6% of the 2085 HIV-positive patients seen in the clinic during the study period) were dually infected. Twelve patients were male. Six patients (46%) had previously been treated for syphilis, 4 with intramuscular penicillin G benzathine only. Four patients (31%) had isolated anterior uveitis, 3 patients (23%) had anterior and intermediate uveitis, and 5 patients (38%) had panuveitis. One patient (8%) presented with optic nerve and retinal atrophy. Eight patients were treated with intravenous penicillin, 3 with intravenous and intramuscular penicillin, and 1 with intravenous ceftriaxone sodium. Of the 12 patients for whom follow-up examinations were available after treatment, ocular inflammation decreased in 11 (92%) and visual acuity improved in 8 (67%). Rapid plasma reagin titers decreased a median of 64-fold compared with pretreatment levels, and all patients with reactive cerebrospinal fluid who underwent pretreatment and posttreatment lumbar punctures normalized following therapy with intravenous antibiotics. Syphilis is an uncommon cause of uveitis in HIV-infected patients. Anterior uveitis is the most common ocular manifestation, but panuveitis is more common than isolated anterior uveitis. Intravenous penicillin is effective therapy.

Spinal cord syphilis associated with human immunodeficiency virus infection: A treatable myelopathy

A 33-year-old woman, seropositive for human immunodeficiency virus type 1 (HIV-1), presented with progressive weakness and numbness of the lower extremities, gait difficulties, and urinary frequency. Physical examination revealed bilateral lower extremity weakness, a left-sided Babinski reflex, and a thoracic sensory level to pinprick at TS. Serum rapid plasma reagin was 1:64, and fluorescent treponemal antibody-absorption (FTA-ABS) was 4+. Examination of the cerebrospinal fluid showed a mononuclear pleocytosis and reactive FTA-ABS, The myelopathy responded promptly to high-dose intravenous aqueous penicillin. Syphilis needs to be considered in the differential diagnosis of any patient who develops a myelopathy in association with HIV-1 infection. Because of the diverse nature in which syphilis may affect the spinal cord, treatment with intravenous aqueous penicillin, 12 to 24 million units daily, for a minimum of 10 days, should be considered in any HIV-1-seropositive patient with a progressive, unexplained myelopathy and positive serologic studies for syphilis.

Evaluation of cerebrospinal fluid in asymptomatic late syphilis.

To help determine the role of lumbar puncture in evaluation of patients with asymptomatic late syphilis, we reviewed results of cerebrospinal fluid (CSF) testing of 47 asymptomatic patients with syphilis. Syphilis was of unknown duration (n = 27) or known duration of greater than one year (n = 20), and all patients had reactive rapid plasma reagin (RPR) tests and reactive fluorescent treponemal antibody absorption tests. Thirty-two per cent of subjects had abnormal CSF findings; these included elevated protein in nine (19%) of 47 and pleocytosis in six (13%) of 47. In most cases, the etiology of these abnormalities was uncertain. Asymptomatic neurosyphilis, diagnosed on the basis of a reactive Venereal Disease Research Laboratory (VDRL; Atlanta, GA) test of CSF, was present in three (6%) of 47 patients. Of the eight patients with RPR titers of greater than or equal to 1:128, three (38%) had neurosyphilis. These results suggest that lumbar puncture is indicated for patients with asymptomatic late syphilis or syphilis of unknown duration.

The FTA-ABS Test

The fluorescent treponemal antibody absorption (FTA-ABS) test, an excellent confirmatory treponemal test, has been used increasingly for syphilis screening and case detection. To evaluate its performance as an initial test, we did Venereal Disease Research Laboratory (VDRL) slide and FTA-ABS tests on 1,043 patients suspected of having syphilis. When retested in both a local and a reference laboratory, sera from 226 patients with borderline or reactive results demonstrated interlaboratory consistency for the VDRL but not the FTA-ABS. Borderline FTA-ABS results correlated poorly with the diagnosis of syphilis in both laboratories; a reactive FTA-ABS test correlated well only in the reference laboratory. Performance of the test appeared to be diminished by its use in a low-prevalence population and by seemingly minor alterations in the test procedure at the local laboratory.

Spontaneous Reversion of FTA-ABS Test Reactions

In a series of 56 clinically healthy persons with no history of syphilis and negative VDRL tests but reactive fluorescent treponemal antibody absorption (FTA-ABS) tests, 20 spontaneously developed nonreactive FTA-ABS tests in a period of eight months or less. All but one of these had been of 2+ or less fluorescence. In such a situation, the serologic tests for syphilis (VDRL and FTA-ABS tests) should be repeated at intervals for up to a year before coming to a decision regarding the diagnosis of syphilis. Laboratories could facilitate that decision by reporting degrees of fluorescence of the FTA-ABS test.

Treponeme-like forms in chimpanzee aqueous humor and cerebrospinal fluid.

Two hundred and ninety-four specimens of aqueous humor and cerebrospinal fluid from 34 chimpanzees were examined for treponeme-like forms with a direct fluorescent antibody technique. One such form was found in 44 specimens from eight animals having a reactive fluorescent treponemal antibody-absorption (FTA-ABS) test prior to experimental infection, one in 170 specimens from six animals having untreated experimental syphilis of two to three years' duration, and one in 14 specimens of aqueous humor from six animals having pinta of one to two years' duration. None was seen in 49 specimens from animals with non-reactive FTA-ABS tests prior to experimental infection, or in 18 specimens from eight animals examined three to four years following penicillin treatment for experimental syphilis. Seven percent of the fluids examined contained suspicious forms which could not definitely be classified as treponemes.

Spirochetes in the aqueous humor in seronegative ocular syphilis. Persistence after penicillin therapy.

A young woman with a gradual onset of blurred vision was found to have a bitemporal hemianopia. It was possible that these symptoms represented an early optochiasmatic arachnoiditis. Inflammatory eye changes with bilateral neuroretinitis and anterior uveitis were then noted. A protracted course of exacerbations and remissions occurred during a one-year course of systemic steroid therapy. After a reactive fluorescent treponemal antibody absorption test was found, spirochetes were demonstrated in the aqueous humor. The patient was then given more than nine million units of long-acting penicillin. One month later, at a second paracentesis, spirochetes were again found. These organisms were motile on darkfield examination, and stained with fluorescein tagged anti-Treponema pallidumglobulin.