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1. Prepared by:
Tobias, Zelland O.
BS. MedTech

4.  Treponema pallidum –Spp. that responsible for
syphilis.
 From family of Spirochete
 Pathogenic treponemes:
 -T. pallidum
 -T. carateum
 -T. pertenue
 -T. cuniculi
 -T. endemicum

5. Antibodies
 May be directed against T. pallidum or
protein antigen group common to
pathogenic treponemes
 •IgM in early or untreated latent syphilis
 •Rapidly followed by IgG w/c becomes
predominant during secondary stage

6. Non Treponemal VS.
Treponemal
 Non – treponemal indirect
method of blood test for
diagnosis.
 Tests detect biomarkers that are
released during cellular damage.
 Nonspecific antibodies that react
to cardiolipin.
 Measure immunoglobulin.
 Ideally used for qualitative
syphilis screening.
 CDC approved test include
VDRL, RPR.
 React in Treponema pallidum
strains.
 Detect antibodies specific to T.
pallidum.
 Although these tests are typically
more specific than
nontreponemal assays, they will
remain positive.
.

7. Non-Treponemal test Treponemal test
Flocculation Tests
Rapid Plasma Reagin
(RPR)
 Venereal Disease
Research
Laboratory(VDRL)
Treponema
Hemaglutination
Absorption(TPHA)
Fluorescent treponemal
antibody absorption (FTA-ABS)
Cardiolipin Treponemal

8. Serological Test for SYPHILIS
 VDRL (Venereal Disease Research
Laboratory)
 ELISA (Enzyme-Linked Immunosorbent
Assay)
 RPR (Rapid Plasma Reagin)
 FTA-ABS (Fluorescent Treponemal
Antibody Absorption Test)

9.  TPI (Teponema pallidum Immobilization
Test)
 TPPA (Treponema pallidum Particle
Agglutination Assay)
 MHA-TP (Microhemagglutination Assay)
 DARK FIELD MICROSCOPE

10. VDRL
 Screening test for syphilis, routine part of prenatal
care during pregnancy .
 Several states also require screening for syphilis
prior to obtaining a marriage license.
 Measures Antibodies.
 Specimen for the test is SERUM
 Screening test is most likely to be positive in the
secondary and latent stages of syphilis
 Test is not accurate in Early and Tertiary stage.

11.  Positive (Reactive)
 Negative result it means (Non-Reactive)
 Confirm the results with an FTA-ABS test,
which is a more specific syphilis test.
 Body does not always produce antibodies.

12. ELISA
 Reaction is performed on polystyrene, the reaction
is between the Antigen and Antibody
 Polystyrene carriers which have absorbed an
ultrasonicated preparation of T. Pallidum.
 Positive result the carriers (Red-brown-violet)
 Negative (White) does not change
 Check antibodies for syphilis

13. RPR
 RPR test allows to confirm diagnosis and begin
treatment spread of the disease by an infected but
unaware person.
 Similar test to the VDRL.
 Detection present of non-specific antibody.
 Second stage or middle stage is one of the most
accurate stage to perform RPR
 FTA-ABS is confirmatory test.
 Large clamp (Positive)
 NO clumps (Negative)

14. FTA-ABS  Using antibodies specific T.palllidum
 Such tests are more specific than non-treponemal
testing
 Positive earlier and remains positive longer than
VDRL
 Should always be followed to confirm a
positive RPR and/or VDRL test for syphilis
 Highly sensitive but time consuming
 w/fluorescence: REACTIVE; w/o fluorescence:
NONREACTIVE

15. TPI
 Mixing of live Reiter treponemes from a
testicular chancre of rabbit and patient sera
 Immobilization of treponemes = REACTIVE
 Treponemes remain motile = NONREACTIVE
 Observed under dark-field microscope
 Standard test detecting NEUROSYPHILIS.

16. TPPA
 Indirect agglutination assay used for detection and
titration of antibodies.
 Gelatin particles are sensitized with T.
pallidum antigen.
 A negative test shows no clumping of gelatin particles.
 A positive test no clumping of gelatin.
 TPPA has a sensitivity of 85% to 100%, and
a specificity of 98% to 100%. For 1st stage of syphilis.
 Confirmatory test

17. Treponema pallidum
Particle Agglutination

18. TPHA & MHA-TP
 Uses tanned sheep RBCs coated with
antigens from Nichols strain of TP

19. Dark Field Microscope
 Direct detection of the organism and indirect
evidence of infection.
 Molecular assays to detect T pallidum DNA, and
histopathologic examination of biopsies of skin or
mucous membranes.
 Allows visualization of live treponemes.
 Detection on infection before the serological test.
 corkscrew appearance (+)
 + result may indicate type of any stage Syphilis

22. References:
 cdc.gov/std/syphilis/manual.1998/CHAPT5.pdf
 cdc.gov/std/syphilis/stdfact-syphilis.htm
 labtestsonline.org/understanding/analytes/syphilis/t
ab/test/
 nlm.nih.gov/medlineplus/ency/article/003515.htm
 nlm.nih.gov/medlineplus/ency/article/003533.htm
 aphl.org/aphlprograms/infectious/std/Documents/I
D_2009Jan_Laboratory-Guidelines-Treponema-pallidum-
Meeting-Report.pdf