OBJECTIVE: To Establish the shielding threshold value of TP antibody ELISA for unpaid blood donors, so as to shield true positive blood donors from returning to team management. METHODS: The real serological status of 517 samples with anti-TP ELISA reactivity was determined by confirmation test of Treponema pallidum particle agglutination (TPPA). The shielding threshold of TP antibody was preliminarily determined by using 99% specificity of ROC and 95% positive predictive value of percentile method, respectively. 283 TP antibody reactivity specimens routinely tested in our laboratory were selected to determine the applicability of the initial shielding values obtained by the two methods, and finally to determine the shielding threshold values of TP antibody donors. RESULTS: The specific S/CO values of reagent A 99% were 13.33-16.18, that of reagent B 99% was 6.34, that of reagent B 99% was 13.17-19.85, and that of 95% was 6.62. Empirical evidence: 99% specific threshold shielding true positive rates of reagents A and B were 100%, 95% positive expected value shielding true positive rates were 98.4%, 99%. Final determination of 99% specific shielding threshold as a low value of blood donors shielding threshold. The shielding limits of reagent A and B were 13.33 and 13.17. CONCLUSION The shielding threshold of TP antibody ELISA for blood donors established in this study can help to reduce the number of blood donors returning to team management.
Blood Donors ; Enzyme-Linked Immunosorbent Assay ; Humans ; Syphilis ; Syphilis Serodiagnosis ; Treponema pallidum

OBJECTIVETo evaluate the accuracy and precision of 2 kinds of anti-treponema pallidum (anti-TP) ELISA reagents in our laboratory for detecting the anti-TP in voluntary blood donors, so as to provide the data support for use of ELISA reagents after introduction of chemiluminescene immunoassay (CLIA).

METHODSThe route detection of anti-TP was performed by using 2 kinds of ELISA reagents, then 546 responsive positive samples detected by anti-TP ELISA were collected, and the infections status of samples confirmed by treponema pallidum particle agglutination (TPPA) test was identified. The confirmed results of responsive samples detected by 2 kinds of anti-TP ELISA reagents were compared, the accuracy of 2 kinds of anti-TP ELISA reagents was analyzed by drawing ROC and comparing area under curve (AUC), and precision of 2 kinds of anti-TP ELISA reagents was compared by statistical analysis of quality control data from 7.1 2016 to 6.30 2017.

RESULTSThere were no statistical difference in confirmed positive rate of responsive samples and weak positive samples between 2 kinds of anti-TP ELISA reagents. The responsive samples detected by 2 kinds of anti-TP ELISA reagents accounted for 85.53%(467/546) of all responsive samples, the positive rate confirmed by TPPA test was 82.87%. 44 responsive samples detected by anti-TP ELISA reagent A and 35 responsive samples detected by anti-TP ELISA reagent B were confirmed to be negative by TPPA test. Comparison of AUC showed that the accuracy of 2 kinds of anti-TP ELISA reagents was more high, the difference between 2 reagents was not statistically significant. The coefficient of variation (CV) of anti-TP ELISA reagent A and B was 14.98% and 18.04% respectively, which met the precision requirement of ELISA test.

CONCLUSIONThe accuracy and precision of 2 kinds of anti-TP ELISA reagents used in our laboratory are similar, and using any one of anti-TP ELISA reagents all can satisfy the requirements of blood screening.

Blood Donors ; Enzyme-Linked Immunosorbent Assay ; Humans ; Syphilis Serodiagnosis ; Treponema pallidum

Objective: To investigate the changes of proportion on both consistent condom use and syphilis infection among low-fee female sex workers aged 35 and above (LFSW), in order to provide evidence for targeted intervention strategies. Methods: A total of six cities-Liuzhou city and Pingnan couty of Guigang city of Guangxi Zhuang Autonomous Region, Jinghong city of Xishuangbanna Dai autonomous prefecture and Dali city of Dali Bai autonomous prefecture of Yunnan province, Zhangjiajie city and Jianghua Yao autonomous county of Yongzhou city Hunan province were involved in this study, with 60 eligible participants needed in each city, estimated through a pre-study. The first cross-sectional survey was completed from October 2012 to January 2013. Face-to-face questionnaire interview was carried out to collect information on socio-demography, work-related information and condom use situation. Blood was collected for syphilis testing. The second cross-sectional survey was carried out from June to September, 2015 under the same procedure. Results: A total of 371 and 403 eligible participants were included in the first and second survey, respectively. When comparing the two surveys, we noticed that the average age showed a slight change, from 42.4 years to 43.8 years old (t=3.537, P<0.001) and the average price for every commercial sex exchange increased from 36.8 RMB to 49.5 RMB (t=11.961, P<0.001). In the first survey, 46.9% (174/371) of the participants had more than two years of experience working as LFSW, compared to 61.3% (247/403) in the second survey (χ(2)=16.125, P<0.001). Also, 46.9% (174/371) of the participants consistently used condoms with clients in the past month in the first survey versus 64.3% (259/403) (χ(2)=23.641, P<0.001) in the second one. Rates of syphilis infection were found from 15.9% (59/371) in the first survey reduced to 7.2% (29/403) in the second survey (χ(2)=14.533, P<0.001). Conclusion: Compared with the first survey, the proportion of consistent condoms use showed an increase. Although the proportion of syphilis infection decreased in the second survey, the scope did not meet the criteria on syphilis, set by the government. Targeted intervention strategies on condom promotion and syphilis control should be implemented consistently in this population.
Adult ; China/epidemiology* ; Condoms/trends* ; Cross-Sectional Studies ; Female ; Humans ; Prevalence ; Risk Factors ; Safe Sex ; Sex Work ; Sex Workers ; Sexually Transmitted Diseases/epidemiology* ; Surveys and Questionnaires ; Syphilis/prevention & control* ; Syphilis Serodiagnosis

PURPOSE: To report a case of acute interstitial keratitis as the first clinical sign in a patient with latent syphilis. CASE SUMMARY: A 23-year-old female presented with visual impairment and discomfort in her right eye that developed 3 days earlier. The visual acuity in the right eye was 20/200 and corrected to 20/100, and slit lamp examination showed round sub-epithelial opacification in the central cornea with stromal edema and neovascularization on the cornea of the right eye. Whole body tests including serological tests were performed. Under the suspicion of acute interstitial keratitis, topical antibiotics and steroids were applied 4 times a day initially. Serological tests were reactive for venereal disease research laboratory test (VDRL). Under the suspicion of acute interstitial keratitis due to syphilis, fluorescent treponemal antibody absorption test IgM/IgG (FTA-ABS IgM/IgG) was performed; a positive result for FTA-ABS IgG led to diagnosis of acute interstitial keratitis with latent syphilis. During treatment, systemic doxycycline 200 mg for 4 weeks with topical antibiotics and steroids were administered, the opacity and edema of the cornea regressed after 2 weeks of treatment, and visual acuity in the patient's right eye improved to 20/20. CONCLUSIONS: We report an unusual case of acute interstitial keratitis as the first clinical manifestation of latent syphilis in an immunocompetent patient.
Anti-Bacterial Agents ; Cornea ; Diagnosis ; Doxycycline ; Edema ; Female ; Fluorescent Treponemal Antibody-Absorption Test ; Humans ; Immunoglobulin G ; Keratitis* ; Patient Rights ; Serologic Tests ; Sexually Transmitted Diseases ; Slit Lamp ; Steroids ; Syphilis* ; Syphilis, Latent ; Treponema pallidum ; Vision Disorders ; Visual Acuity ; Young Adult

BACKGROUND: Automated analyzer-based nontreponemal serological tests for syphilis (STS) have been used for several decades. OBJECTIVE: In this study, we evaluated serological responses to treatment and proposed clinical guidelines for automated STS. METHODS: This retrospective cohort study analyzed human immunodeficiency virus-negative syphilis patients who were diagnosed with automated rapid plasma reagin (auto RPR) tests as a nontreponemal STS, and who also received the fluorescent treponemal antibody-absorption test as a confirmatory test. The ratio of auto RPR values after treatment against those at baseline was defined as the auto RPR ratio for the analysis of the serological response to treatment. The cutoff value for reliable seroreversion prediction was assessed with receiver-operating-characteristic curves. RESULTS: Overall, 89.7% of participants (78/87) seroreverted and 10.3% of participants (9/87) remained serofast during the two-year follow-up period. We were unable to describe trends in the changes among auto RPR values within six months after treatment because of high variation. All of the patients who had an auto RPR ratio ≥1.0 after six months continuously had positive serologic results during their 24-month follow-up and were classified as a serofast group. The receiver-operating-characteristic curves revealed a 25% reduction in auto RPR values nine months after treatment and predicted seroreversion with a sensitivity of 96.2% and a specificity of 100%. CONCLUSION: The most important primary checkpoint for syphilis treatment response is an increase in automated nontreponemal STS six months after treatment. Thus, we recommend monitoring the treatment response with an auto RPR.
Cohort Studies ; Fluorescent Treponemal Antibody-Absorption Test ; Follow-Up Studies ; Humans* ; Plasma ; Retrospective Studies ; Sensitivity and Specificity ; Serologic Tests* ; Sexually Transmitted Diseases ; Syphilis Serodiagnosis ; Syphilis* ; Treponema pallidum

BACKGROUNDThe false positive in conventional syphilis serological test was found in patients with multiple myeloma (MM).

OBJECTIVETo investigate the relationship between the M-protein of patients with MM and the false positive in conventional syphilis serologic test.

METHODSThe M-protein of 68 MM cases was typed with immunofixation electrophoresis and 68 cases of MM were screened with non-specific and specific syphilis serologic tests, then the samples with syphilic serological positive were chosen and confirmed with immonobloting test, finally the relationship between M protein of MM and the false positive of syphilis serological test were analysed.

RESULTSFour out of 68 cases showed the positive in syphilis serological test and further were confimed to be false positive by immunoblotting test, the false positive rate was nearly 6%. The M-protein of MM patients in our hospital mostly possessed IgG, κ type, followed by IgA, κ type, light chain κ type. In general, κ : λ = 2.4 : 1. Among samples of 4 cases with syphilis serological positive 2 cases were of IgG and κ type, 1 case was of IgG, λ type, another 1 case was IgA, κ type.

CONCLUSIONThe M-protein of IgG and IgA types in MM patients results in syphilis serological false positive reaction. The clinicians and laboratorial technicians should pay a great attention to screen the MM patients for the false positive syphilis serological test so as to avoid the misdiagnosis and subsequent embarassment.

Diagnostic Errors ; False Positive Reactions ; Humans ; Immunoglobulin A ; classification ; Immunoglobulin G ; classification ; Multiple Myeloma ; diagnosis ; Myeloma Proteins ; metabolism ; Syphilis ; diagnosis ; Syphilis Serodiagnosis

Neurosyphilis can present with various clinical symptoms. We report a patient with multiple cranial neuropathy that, mimicked tuberculosis, but was finally diagnosed as neurosyphilis. A 38-year-old man was admitted due to subacutely progressive hearing loss. Brain MRI revealed multiple dural enhanced masses on contrast-enhanced T1 weighted images. Brain biopsy of the dural enhanced lesion revealed chronic granulomatous inflammation with coagulation necrosis, compatible with syphilitic gumma. Serum venereal disease research laboratory and fluorescent treponemal antibody absorption test results were positive. Treatment with penicillin resolved the patient's symptom.
Adult ; Biopsy ; Brain ; Cranial Nerve Diseases* ; Fluorescent Treponemal Antibody-Absorption Test ; Hearing Loss ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Necrosis ; Neurosyphilis* ; Penicillins ; Sexually Transmitted Diseases ; Tuberculosis

PURPOSE: To report the manifestation of ocular syphilis combined with neurosyphilis in patients who present with uveitis clinically and are diagnosed initially by an ophthalmologist. METHODS: This study is a retrospective, clinical investigation of seven male patients with ocular syphilis from a single tertiary center between 2009 and 2012. RESULTS: The average age of the patients at onset was 44.4 years (range, 33-71 years). Posterior segment involvement was found in all patients. Two patients had papillitis. In serologic testing, all patients had positive responses to Venereal Disease Research Laboratory (VDRL), fluorescent treponemal antibody-absorption test (FTA-ABS) and Treponema pallidum hemagglutination (TPHA). In fluorescein angiography (FAG), retinal vascular and disc leakage was the most common finding. Cerebrospinal fluid (CSF) analysis was performed for six patients and demonstrated positive CSF FTA-ABS and CSF TPHA tests in all patients. CSF VDRL was reactive in 2 patients (33.3%). CONCLUSIONS: All patients with ocular syphilis were diagnosed with neurosyphilis based on the analysis of CSF with FTA-ABS and TPHA. Ophthalmologists play an important role in the early diagnosis and treatment of syphilis.
Cerebrospinal Fluid ; Early Diagnosis ; Fluorescein Angiography ; Fluorescent Treponemal Antibody-Absorption Test ; Hemagglutination ; Humans ; Male ; Neurosyphilis* ; Papilledema ; Retinaldehyde ; Retrospective Studies ; Serologic Tests ; Sexually Transmitted Diseases ; Syphilis* ; Treponema pallidum ; Uveitis

BACKGROUND: The Korean Red Cross blood laboratory centers use Treponema pallidum particle agglutination assay on the PK7300 instrument as a primary donor screening test for syphilis, and semi-quantitative TPPA and RPR card as supplementary tests. We compared the results of Treponema pallidum latex agglutination and RPR tests on the automated analyzer with those of TPPA and RPR card tests. METHODS: A total of 1,000 samples with negative TPPA results and 103 samples with positive TPPA results (> or =1:80 titers) were evaluated in this study. HiSens Auto TP, RPR (HBI, Anyang, Korea) and Mediace TPLA, RPR (Sekisui, Tokyo, Japan) reagents were used on the automated analyzer. FTA-ABS test was performed as a confirmatory test to evaluate the sensitivity and specificity of HiSens Auto TPLA, RPR and Mediace TPLA, RPR reagents. RESULTS: The concordance rate between HiSens Auto TP, Mediace TPLA and TPPA was 95.5% and 95.4%, respectively. The concordance rate between HiSens Auto RPR, Mediace RPR and RPR card was 79.6% and 80.6%, respectively. Sensitivity of HiSens Auto TP and Mediace TPLA was 87.7% and 90.8%, respectively, and specificity was 99.5% and 99.0%, respectively. CONCLUSION: Despite the high concordance rate between TPLA and TPPA, there were negative TPLA results which were positive for both TPPA and FTA-ABS tests. Therefore, changing the primary donor screening test for syphilis from current TPPA to TPLA on the automated analyzer requires further investigation.
Agglutination* ; Blood Donors* ; Donor Selection ; Fluorescent Treponemal Antibody-Absorption Test ; Gyeonggi-do ; Humans ; Indicators and Reagents ; Latex* ; Plasma* ; Red Cross ; Sensitivity and Specificity ; Syphilis ; Treponema pallidum*

No abstract available.
Anti-Bacterial Agents/therapeutic use ; Diagnosis, Differential ; Electroretinography ; Eye Infections, Bacterial/*diagnosis/drug therapy ; Fluorescein Angiography ; Humans ; Male ; Middle Aged ; Penicillin G Benzathine/therapeutic use ; Retinitis/*diagnosis/drug therapy ; Scotoma/*diagnosis/drug therapy ; Syphilis/*diagnosis/drug therapy ; Syphilis Serodiagnosis ; Tomography, Optical Coherence ; Visual Acuity/physiology