Creegan Linda, Bauer Heidi M, Samuel Michael C, Klausner Jeffrey, Liska Sally, Bolan Gail
California Department of Health Services, Sexually Transmitted Diseases (STD) Control Branch, 300 Frank H Ogawa Plaza, Suite 520, Oakland, CA 94612-2032, USA.
Sex Transm Dis. 2007 Dec;34(12):1016-1018.
Because definitive methods for diagnosing primary syphilis are limited, it is important to optimize the sensitivity of serodiagnosis.
To determine the most sensitive testing approach to the diagnosis of primary syphilis, using the commonly available serologic tests: the Venereal Disease Research Laboratory (VDRL) test and the Treponema pallidum particle agglutination (TP-PA) test.
Sensitivities of 2 serologic testing strategies for primary syphilis were compared among 106 darkfield-confirmed cases treated in San Francisco from January 2002 through December 2004.
The sensitivity of the diagnostic strategy using VDRL confirmed by TP-PA was 71% (95% CI, 61%-79%). Substituting Rapid Plasma Reagin test for VDRL in a subset of 51 patients produced the same sensitivity (71%; 95% CI, 56%-83%). The sensitivity of TP-PA as the first-line diagnostic test was 86% (95% CI, 78%-92%). The sensitivity of the former approach was significantly lower among HIV-positive patients, compared with HIV-negative patients (55% vs. 77%, P = 0.05).
The TP-PA test as the first-line diagnostic test yielded higher sensitivity for primary syphilis than did the use of the currently recommended strategy.
由于诊断一期梅毒的确定性方法有限，优化血清学诊断的敏感性很重要。
使用常用的血清学检测方法，即性病研究实验室（VDRL）试验和梅毒螺旋体颗粒凝集（TP-PA）试验，确定诊断一期梅毒最敏感的检测方法。
比较了2002年1月至2004年12月在旧金山接受治疗的106例经暗视野检查确诊的病例中，两种一期梅毒血清学检测策略的敏感性。
采用TP-PA确认的VDRL诊断策略的敏感性为71%（95%CI，61%-79%）。在51例患者的亚组中，用快速血浆反应素试验替代VDRL，敏感性相同（71%；95%CI，56%-83%）。TP-PA作为一线诊断试验的敏感性为86%（95%CI，78%-92%）。与HIV阴性患者相比，前一种方法在HIV阳性患者中的敏感性显著较低（55%对77%，P=0.05）。
与目前推荐的策略相比，TP-PA试验作为一线诊断试验对一期梅毒具有更高的敏感性。
