The document compares non-treponemal and treponemal tests for syphilis diagnosis, outlining their principles, sensitivities, and specificities. It emphasizes the advantages and disadvantages of each test type, recommending non-treponemal tests for screening and treponemal tests for confirmation of infection. Additionally, it discusses testing algorithms for congenital syphilis evaluation based on maternal serology results.

3. COMPARISON OF TESTS WITH STAGE

4. NON TREPONEMAL TESTS
• Detects phospholipid antibodies to lipoidal antigens
(cardiolipin, lecithin, cholesterol).
• Based on the principle of flocculation.
• Detects both IgM and IgG; can’t differentiate the two.
1. Rapid, simple and inexpensive.
2. Helps monitor response to Rx.
3. Helps to detect re-infection.
1. ↓ Sensitivity in 1° & latent syp.
2. Biological False Positives.
3. False Negative (Prozone reaction)
ADVANTAGES DISADVANTAGES

5. 1. CONVENTIONAL TESTS
A. FTA-ABS
B. MHA-TP
C. TP-HA
D. TP-PA
TREPONEMAL TESTS
2. EIA
3. IMMUNOBLOTS
4. CHEMILUMINESCENCE IMMUNOASSAY
5. RAPID POC

6. FTA-ABS
• Basis: Indirect immunofluorescence technique.
• Sensitivity:
1. Primary: 82-90%
2. Secondary: 100%
3. Latent: 96%
4. Tertiary: 100%
• Specificity: 94.5-98.6%

7. FTA-ABS

8. MHA-TP
• Basis: Agglutination principle.
• Sensitivity:
1. Primary: 57-88%
2. Secondary: 96-100%
3. Latent: 96-97%
4. Tertiary: 98-100%
• Specificity: 99%

9. MHA-TP
It uses sensitized sheep erythrocytes coated with T. pallidum
(Nichol’s strain), which agglutinate with anti-treponemal IgM
and IgG antibodies.

10. TP-HA
• Basis: Passive agglutination principle.
• Sensitivity:
1. Primary: 86%
2. Secondary: 100%
3. Latent: 100%
4. Tertiary: 100%
• Specificity: 100%

11. TP-HA

12. TP-PA
• Basis: Passive agglutination principle.
• Sensitivity:
1. Primary: 85-97%
2. Secondary: 100%
3. Latent: 100%
4. Tertiary: 96.2-100%
• Specificity: 97.6-100%

13. TP-PA
• Similar to TP-HA, but instead of sheep RBCs, gelatin particles
are used.

14. CONVENTIONAL TREPONEMAL TESTS

15. ENZYME IMMUNOASSAYS
• They can be used to detect IgM, IgG or combined.
• They use recombinant antigens of treponemas.
• They are the most sensitive (94.7%–99.1%) and specific (100%) of
all treponemal tests, particularly in secondary syphilis.
• They are amenable to automation, removing the variation and
subjectivity of the human reader.
• They use several different formats, including (i) antibody class
capture, (ii) sandwich capture, and (iii) competitive assay.
• IgM-specific assays can assist in distinguishing between early and
late infections.

16. HIGH PREVALENCE
Non-Treponemal test to
screen current infection
Treponemal test to confirm presence
Non-Treponemal test
to monitor prognosis
LOW PREVALENCE
Treponemal test to screen
current / past infection
Non-Treponemal test to
screen current infection
Non-Reactive Reactive
Different Treponemal test
to confirm presence
TESTING ALGORITHM

22. CONGENITAL SYPHILIS
• All infants born to mothers who have reactive nontreponemal
and treponemal test results should be evaluated for congenital
syphilis.
• A quantitative nontreponemal test should be performed on
infant serum and, if reactive, the infant should be examined
thoroughly for evidence of congenital syphilis.

23. CONGENITAL SYPHILIS

24. REFERENCES
1. Bhushan Kumar, Sexually Transmitted Infections.
2. King and Nicole, Sexually Transmitted Diseases.
3. Vinod K Sharma, Sexually Transmitted Diseases & AIDS.
4. James H. Jorgensen (editor) et. al., Manual of Clinical Microbiology.
5. The laboratory diagnosis of syphilis. Can J Infect Dis Med Microbiol.
2005;16(1):45-51.