Becker G D
Section of Otolaryngology (Head and Neck Surgery), Wadsworth Hospital Center, Los Angeles, CA 90073.
Arch Otolaryngol. 1976 Dec;102(12):729-31. doi: 10.1001/archotol.1976.00780170047005.
The clinician occasionally encounters a patient whose cochleovestibular symptoms are thought to be due to late syphilis mainly on the basis of a reactive FTA-ABS test. I describe 21 such patients, 11 of whom had either a spurious- or a false-positive reaction. The following suggestions may avoid an inaccurate diagnosis of late syphilis in such patients: (1) repeat all reactive serological tests for syphilis (STS); (2) rule out false-positive reactions; (3) request the degree of fluorescence (1+ to 4+) on all reactive FTA-ABS tests; (4) obtain a Treponema pallidum immobilization (TPI) test on all patients with repeatedly reactive (1+) FTA-ABS tests--a nonreactive TPI test rules out the diagnosis of syphilis; (5) if a TPI test cannot be performed, a repeatedly reactive (1+) FTA-ABS test in the absence of a reactive nontreponemal STS probably represents a false-positive reaction; (6) clinical judgment is the final determinant of whether a patient has or should be treated for late syphilis.
临床医生偶尔会遇到这样的患者，其耳蜗前庭症状主要基于梅毒螺旋体荧光抗体吸收试验（FTA-ABS）呈反应性而被认为是由晚期梅毒引起的。我描述了21例这样的患者，其中11例出现了假反应或假阳性反应。以下建议可避免对此类患者晚期梅毒的误诊：（1）重复所有梅毒反应性血清学检测（STS）；（2）排除假阳性反应；（3）要求对所有反应性FTA-ABS试验给出荧光强度（1+至4+）；（4）对所有FTA-ABS试验反复呈反应性（1+）的患者进行梅毒螺旋体制动（TPI）试验——TPI试验无反应可排除梅毒诊断；（5）如果无法进行TPI试验，在非梅毒螺旋体STS无反应的情况下，FTA-ABS试验反复呈反应性（1+）可能代表假阳性反应；（6）临床判断是患者是否患有或应接受晚期梅毒治疗的最终决定因素。
