RSS Feeds
Diagnostic Decision
Syphilis Tests in Diagnostic and Therapeutic Decision Making
Abstract
Predictive value calculations were used to derive diagnostic guidelines for syphilis. Specificity of the VDRL (Venereal Disease Research Laboratory) and treponemal tests is high in healthy persons but less in elderly and ill persons. Sensitivity of the VDRL test is high in secondary and early latent syphilis but reduced in primary and late syphilis or in cerebrospinal fluid evaluations. Primary syphilis should be diagnosed by darkfield microscopy, with VDRL confirmation for atypical lesions. Screening of asymptomatic persons with the VDRL test, followed by treponemal test confirmation on positive sera, is recommended for all pregnant women, contacts of persons with infectious syphilis, and other high-risk groups. Quantitative VDRL assessment at 3, 6, and 12 months after treatment should be used to assess the adequacy of treatment for both late latent and early syphilis. Cerebrospinal fluid VDRL assessment and cell count should be restricted to seropositive persons with a high risk of neurosyphilis.
Article and Author Information
-
▸From the South Australian Health Commission; Adelaide, South Australia, Australia.
-
▸This paper was commissioned by the Blue Cross-Blue Shield Medical Necessity Project, under auspices of the Society for Research and Education in Primary Care Internal Medicine (SREPClM), and is the third in a series being published in the Diagnosis and Treatment section. Harold C. Sox, Jr., MD., is the editor for the series, and these papers are also being reviewed by John M. Eisenberg, M.D., and Sankey V. Williams, M.D., our consultants for Diagnostic Decision papers, as well as by selected manuscript consultants. This series will be published in a collective reprint, the availability of which will be announced later. The reprint will include the introductory article by Dr. Sox, which appeared on pages 60-66 of the January issue.—The Editor.
-
▸Requests for reprints should be addressed to Gavin Hart, M.D., M.P.H.; Director, STD Services, P.O. Box 65, Rundle Mall; Adelaide 5000, Australia.
- © 1986 American College of Physicians
