Larsen S A, Steiner B M, Rudolph A H
Division of Sexually Transmitted Diseases Laboratory Research, Centers for Disease Control and Prevention, Atlanta, Georgia 30333.
Clin Microbiol Rev. 1995 Jan;8(1):1-21. doi: 10.1128/CMR.8.1.1.
The lack of a method for demonstrating the presence of Treponema pallidum by growth necessitates the use of alternative methods. Traditionally, these methods are divided into direct detection methods (animal inoculation, dark-field microscopy, etc.) and serologic tests for the presence of patient antibody against T. pallidum. Serologic methods are further divided into two classes. One class, the nontreponemal tests, detects antibodies to lipoidal antigens present in either the host or T. pallidum; examples are the Venereal Disease Research Laboratory and rapid plasma reagin and tests. Reactivity in these tests generally indicates host tissue damage that may not be specific for syphilis. Because these tests are easy and inexpensive to perform, they are commonly used for screening, and with proper clinical signs they are suggestive of syphilis. The other class of test, the treponemal tests, uses specific treponemal antigens. Confirmation of infection requires a reactive treponemal test. Examples of the treponemal tests are the microhemagglutination assay for antibodies to T. pallidum and the fluorescent treponemal antibody absorption test. These tests are more expensive and complicated to perform than the nontreponemal tests. On the horizon are a number of direct antigen, enzyme-linked immunosorbent assay, and PCR techniques. Several of these techniques have shown promise in clinical trials for the diagnosis of congenital syphilis and neurosyphilis that are presently difficult to diagnose.
由于缺乏通过培养来证明梅毒螺旋体存在的方法，因此需要使用其他方法。传统上，这些方法分为直接检测方法（动物接种、暗视野显微镜检查等）和检测患者抗梅毒螺旋体抗体的血清学检测。血清学方法进一步分为两类。一类是非梅毒螺旋体检测，检测宿主或梅毒螺旋体中存在的类脂抗原抗体；例如性病研究实验室试验和快速血浆反应素试验。这些检测中的反应性通常表明宿主组织损伤，可能并非梅毒所特有。由于这些检测操作简便且成本低廉，它们通常用于筛查，结合适当的临床症状可提示梅毒。另一类检测是梅毒螺旋体检测，使用特定的梅毒螺旋体抗原。感染的确认需要梅毒螺旋体检测呈阳性。梅毒螺旋体检测的例子有梅毒螺旋体抗体微量血凝试验和荧光梅毒螺旋体抗体吸收试验。这些检测比非梅毒螺旋体检测更昂贵且操作更复杂。即将出现多种直接抗原、酶联免疫吸附测定和聚合酶链反应技术。其中一些技术在目前难以诊断的先天性梅毒和神经梅毒的临床试验诊断中已显示出前景。
