Geusau Alexandra, Kittler Harald, Hein Ulrike, Dangl-Erlach Edda, Stingl Georg, Tschachler Erwin
Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases (DIAID), Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna.
Int J STD AIDS. 2005 Nov;16(11):722-6. doi: 10.1258/095646205774763207.
This retrospective study on syphilis screening at the sexually transmitted infection (STI) unit of a University Department emphasizes the necessity of a treponemal-specific test as the appropriate screening test. The Venereal Disease Research Laboratory (VDRL) test for syphilis screening may, under certain circumstances, yield positive results in patients not infected with Treponema pallidum, a phenomenon referred to as biological false-positive (BFP) VDRL test. The aim of this study was to determine the frequency of BFP tests in a large sample of sera. In this retrospective study, we analysed the results of parallel VDRL and T. pallidum haemagglutination (TPHA) testing of a total of 514,940 blood samples obtained from patients at the Vienna General Hospital between January 1988 and November 1999. Patients' sera with incomplete data on stage and sex and duplicate sera were excluded, leaving 300,000 sera for analysis. The seroprevalence for syphilis was 1.77% (n = 5320), as determined by a positive TPHA test. It was significantly higher in male than in female patients (2.03% versus 1.58%, P<0.001). Of the patients reactive in the TPHA test, 3257 (61.2%) were negative in the VDRL. With regard to reactivity in VDRL testing, 2799 patients (0.92%) of the study population were positive, of whom 736 (26%) were biological false positive. BFP reactivity was found in 0.24% of all patients and was significantly higher in women than in men (0.27% versus 0.20%, P<0.001) and in patients over 60 years of age (0.34%) as compared with those under 60 (0.25%, P<0.001). This proportion might be even higher, as reactivity in the VDRL at 1:0 and 1:2 dilutions without a positive treponemal test was not reported. The subgroup of HIV-positive patients (n = 1415) revealed a 10-fold higher rate of BFP tests (2.1% versus 0.24), an effect being statistically significant. In a low syphilis prevalence population, BFP reactions comprise a high proportion of all VDRL reactors. Therefore, the use of the VDRL as a screening procedure is challenged.
这项针对某大学科室性传播感染（STI）单元梅毒筛查的回顾性研究强调了采用梅毒螺旋体特异性检测作为合适筛查检测的必要性。用于梅毒筛查的性病研究实验室（VDRL）检测在某些情况下，可能会在未感染梅毒螺旋体的患者中得出阳性结果，这种现象被称为VDRL检测的生物学假阳性（BFP）。本研究的目的是确定大量血清样本中BFP检测的频率。在这项回顾性研究中，我们分析了1988年1月至1999年11月期间从维也纳总医院患者处获得的总共514,940份血样的VDRL和梅毒螺旋体血凝试验（TPHA）平行检测结果。排除了分期和性别数据不完整的患者血清以及重复血清，剩余300,000份血清用于分析。通过TPHA检测呈阳性确定梅毒血清阳性率为1.77%（n = 5320）。男性患者的血清阳性率显著高于女性患者（2.03%对1.58%，P<0.001）。在TPHA检测呈阳性的患者中，3257例（61.2%）VDRL检测为阴性。关于VDRL检测的反应性，研究人群中有2799例患者（0.92%）呈阳性，其中736例（26%）为生物学假阳性。BFP反应在所有患者中的比例为0.24%，女性患者中的比例显著高于男性（0.27%对0.20%，P<0.001），60岁以上患者中的比例（0.34%）高于60岁以下患者（0.25%，P<0.001）。由于未报告1:0和1:2稀释度下VDRL反应性且梅毒螺旋体检测未呈阳性的情况，这一比例可能更高。HIV阳性患者亚组（n = 1415）的BFP检测率高出10倍（2.1%对0.24%），这种效应具有统计学意义。在梅毒患病率较低的人群中，BFP反应在所有VDRL反应阳性者中占比很高。因此，将VDRL用作筛查程序受到了挑战。
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