{"id":2143,"date":"2022-08-04T17:05:38","date_gmt":"2022-08-04T05:05:38","guid":{"rendered":"https:\/\/www.awanuilabs.co.nz\/south\/otagosouthland\/?page_id=2143"},"modified":"2022-08-04T17:05:39","modified_gmt":"2022-08-04T05:05:39","slug":"syphilis","status":"publish","type":"page","link":"https:\/\/www.awanuilabs.co.nz\/south\/otagosouthland\/referrers\/microbiology-resources\/how-do-i-diagnose\/syphilis\/","title":{"rendered":"Syphilis"},"content":{"rendered":"\n<p><strong>Infection:<\/strong> Syphilis; <em>Treponema pallidum<\/em> infection; many other historical names<\/p>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Brief description:<\/summary><div class=\"ab-accordion-text\">\n<ul><li>A sexually transmitted bacterial infection.<\/li><li>Typically begins as a painless ulcer (primary syphilis) at point of inoculation (i.e. usually on genitals, but can be e.g. oral if acquired via oral sex). Often goes unnoticed. If untreated can then disseminate (secondary syphilis), most commonly seen as a generalised rash. May then over a longer period cause tertiary syphilis e.g. chronic neurologic, vascular disease.<\/li><li>Highest, and increasing, incidence seen in men who have sex with men (MSM), however increasing in women also. Can cause serious congenital infection.<\/li><\/ul>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Did you know?<\/summary><div class=\"ab-accordion-text\">\n<p>Syphilis can present in many different ways: it has been known as \u2018the great mimicker\u2019.<\/p>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Who should I test?<\/summary><div class=\"ab-accordion-text\">\n<ul><li>Due to <strong>increasing incidence<\/strong>, the fact presentations can be <strong>highly variable<\/strong>, and testing is straightforward, the <strong>threshold for testing should be low<\/strong>.<\/li><li><strong>Any<\/strong> undiagnosed genital <strong>ulcer<\/strong> in a sexually active person should prompt testing.<\/li><li><strong>MSM<\/strong>: test at least annually, and with any <strong>unexplained<\/strong> <strong>systemic<\/strong> or <strong>genital<\/strong> symptoms.<\/li><\/ul>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Test of choice:<\/summary><div class=\"ab-accordion-text\">\n<p>Request <strong><a href=\"https:\/\/scg.aphg.co.nz\/#!\/WEL\/details\/SY\">Syphilis serology<\/a><\/strong><\/p>\n\n\n\n<p>Can answer two questions:<\/p>\n\n\n\n<ul><li>Has this person <strong>ever<\/strong> had infection with syphilis (including if treated\/cleared)?<ul><li><strong>EIA and TPPA<\/strong><\/li><\/ul><\/li><li>Does this person have current <strong>active<\/strong> infection?<ul><li><strong>RPR<\/strong><\/li><\/ul><\/li><\/ul>\n\n\n\n<p><strong>Syphilis EIA <\/strong>detects anti-treponemal antibodies (a <strong>\u2018treponemal\u2019 <\/strong>test). These develop <strong>shortly after primary infection<\/strong> and usually last <strong>lifelong<\/strong> i.e. indicate infection <strong>at some stage<\/strong>.<\/p>\n\n\n\n<ul><li>Excellent<strong> sensitivity &#8211; <\/strong>a<strong> negative <\/strong>result<strong> excludes <\/strong>syphilis unless<strong> very early <\/strong>infection\/treatment, or rarely in HIV\/immune compromise<\/li><li>Good <strong>specificity<\/strong> &#8211; however, a second test is used to <strong>confirm<\/strong> a positive result, as <strong>false positives<\/strong> can occur.<ul><li><strong>TPPA<\/strong> (another <strong>\u2018treponemal\u2019<\/strong> test) is used for this purpose<ul><li>EIA<strong> pos <\/strong>&amp;TPPA<strong> pos <\/strong>= treponemal infection <strong>at some stage. <\/strong><em>Note,<strong> <\/strong>other treponemal infections, e.g. <strong>Yaws<\/strong>, give the <strong>same result.<\/strong><\/em><\/li><li>EIA<strong> pos <\/strong>&amp;TPPA<strong> neg&nbsp;<\/strong>= <strong>false positive EIA<\/strong> (most common explanation) or <strong>very early infection.<\/strong><\/li><\/ul><\/li><\/ul><\/li><\/ul>\n\n\n\n<p><strong>RPR<\/strong> detects non-specific antibodies (a \u2018<strong>non-treponemal<\/strong>\u2019 test) caused by <strong>active infection<\/strong>.<\/p>\n\n\n\n<ul><li>This is <strong>added on automatically<\/strong> by the lab in patients with a positive EIA and TPPA.<\/li><li>Unlike EIA\/TPPA, which remain positive regardless, the value of this test <strong>changes over time<\/strong> due to <strong>treatment<\/strong> or the <strong>immune response<\/strong> to infection.<\/li><li>Used to assess for <strong>inactive vs active infection<\/strong> and <strong>response to treatment<\/strong>.<\/li><\/ul>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Tests to avoid\/specialist tests:<\/summary><div class=\"ab-accordion-text\">\n<p><strong><a href=\"https:\/\/scg.aphg.co.nz\/#!\/WEL\/details\/_ptg3251\">Syphilis PCR<\/a> of a lesion<\/strong><\/p>\n\n\n\n<ul><li>Rarely offers additional information over serology. Reserved for specialist use.<\/li><\/ul>\n<\/div><\/details><\/div>\n\n\n\n<div class=\"wp-block-atomic-blocks-ab-accordion ab-block-accordion\"><details><summary class=\"ab-accordion-title\">Other considerations:<\/summary><div class=\"ab-accordion-text\">\n<p>Is <strong>notifiable<\/strong> and requires <strong>contact<\/strong> <strong>tracing<\/strong>. Sexual Health should be involved in the management of people with suspected or proven syphilis.<\/p>\n<\/div><\/details><\/div>\n","protected":false},"excerpt":{"rendered":"Infection: Syphilis; Treponema pallidum infection; many other historical names","protected":false},"author":18,"featured_media":0,"parent":2060,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-left-sidebar.php","meta":{"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.2 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Syphilis &#8212; Awanui Labs \u2013 Otago, Southland<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.awanuilabs.co.nz\/south\/otagosouthland\/referrers\/microbiology-resources\/how-do-i-diagnose\/syphilis\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Syphilis &#8212; 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