Sensitivity of VDRL/RPR in tertiary syphilis - USMLE Forums
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Old 11-20-2011
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Bacteria Sensitivity of VDRL/RPR in tertiary syphilis

I was very sure about this that VDRL/RPR have greater sensitivities in 2' n 3' syphilis....................before listening to the relevant dr. Fischer tape..........he says that for tertiary syphilis, the sensitivity for VDRL/RPR decreases to 75%............coz antibodies become lesser by that time..........but in mtb 2 n everywhere said.......even in UW............dat the sensitivities are 99% n 95% for 2' n 3' syphilis respectively..........i m so confused few weeks before the exam ..........anybody?
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Old 11-20-2011
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Default testing blood vs CSF?

From USPSTF testing blood?!?
Screening for Syphilis Infection

"Sensitivity of the RPR and VDRL tests are estimated to be 78 percent to 86 percent for detecting primary syphilis infection, 100 percent for detecting secondary syphilis infection, and 95 percent to 98 percent for detecting latent syphilis infection. Specificity ranges from 85 percent to 99 percent and may be reduced in individuals who have preexisting conditions (i.e., collagen vascular disease, pregnancy, intravenous drug use, advanced malignancy, tuberculosis, malaria, and viral and rickettsial diseases) that produce false-positive results."

UpToDate testing CSF:
"The CSF may be completely normal in tabes dorsalis, or may show a mild lymphocytic pleocytosis with 10 to 50 cells/microL and protein concentrations of 45 to 75 mg/dL. In this form of neurosyphilis, as many as one-quarter of the CSF-VDRL tests are nonreactive.
Unfortunately, the nontreponemal tests (VDRL and RPR) may be nonreactive in late neurosyphilis, particularly in tabes dorsalis. When there is suspicion for late forms of neurosyphilis, serum treponemal tests (FTA-ABS, TPPA, or syphilis EIA) should always be performed. These tests remain reactive for life in virtually all individuals regardless of previous treatment. Reactivity of these serum tests confirms that the patient has had syphilis at some time, and that he or she is at risk for neurosyphilis."

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Al-Saoudi (11-20-2011), step1an (11-20-2011), tangled (11-20-2011)



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