free upc barcode generator excel 2 Percentage of patients with positive serologic tests for syphilis1 in Objective-C

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Table 34 2 Percentage of patients with positive serologic tests for syphilis1
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Although the classic ulcer of syphilis has been described as nontender, nonpurulent, and indurated, only 31% of patients have this triad
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Based on untreated cases VDRL, Venereal Disease Research Laboratory test; FTA-ABS, fluorescent treponemal antibody absorption test
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worthy that Lyme disease may cause a false-positive treponemal test but rarely causes a false-positive reaginic test Final decisions about the significance of the results of serologic tests for syphilis must be based on a total clinical appraisal 2 Microscopic examination In infectious syphilis, T pallidum may be shown by darkfield microscopic examination of fresh exudate from lesions or material aspirated from regional lymph nodes The darkfield examination requires considerable experience and care in the proper collection of specimens and in the identification of pathogenic spirochetes by observing characteristic features of morphology and motility Repeated examinations may be necessary Darkfield examination of oral lesions is not recommended due to the presence of nonpathogenic treponemes in the mouth Spirochetes usually are not found in late syphilitic lesions by this technique An immunofluorescent staining technique for demonstrating T pallidum in dried smears of fluid taken from early syphilitic lesions is available Slides are fixed and treated with fluorescein-labeled antitreponemal antibody that has been preabsorbed with nonpathogenic treponemes The slides are then examined for fluorescing spirochetes in an ultraviolet microscope Because of its simplicity and convenience to clinicians (slides can be mailed), this technique has replaced darkfield microscopy in most health departments and medical center laboratories
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reactions are usually of low titer and transient and may be distinguished from true positives by specific treponemal antibody tests False-negative results can be seen when very high antibody titers are present (the prozone phenomenon) If syphilis is strongly suspected and the nontreponemal test is negative, the laboratory should be instructed to dilute the specimen to detect a positive reaction The RPR and VDRL tests are equally reliable, but titers of RPR tend to be higher than the VDRL Thus, when these tests are used to follow disease activity, the same testing method should be used and preferably should be performed at the same laboratory Nontreponemal antibody titers are used to assess adequacy of therapy The time required for the VDRL or RPR to become negative depends on the stage of the disease, the level of the initial titer, and whether the infection is an initial or repeat episode In general, persons with repeat infections, higher initial titers, more advanced stages of disease, or those who are HIV positive at the time of treatment have a slower seroconversion rate and are more likely to remain serofast (ie, titers do not become negative) Data based on currently recommended treatment regimens (see below) suggest that in primary and secondary syphilis it may take 6 months to see a fourfold decrease in titer and 12 months to see an eightfold drop In patients with early latent syphilis, response is even slower, with a fourfold drop in titer taking 12 24 months Seronegativity was seen in 72% of patients with primary syphilis and only 56% of those with secondary syphilis after 3 years b Treponemal antibody tests These tests measure antibodies capable of reacting with T pallidum antigens The T pallidum hemagglutination (TPHA) test and the T pallidum particle agglutination (TPPA) test are comparable in specificity and sensitivity to the fluorescent treponemal antibody absorption test (FTA-ABS) The TPPA test, because of ease of performance, has supplanted the FTA-ABS test as the means of confirming the diagnosis of syphilis The treponemal tests are of value principally in determining whether a positive nontreponemal antigen test is falsepositive or is indicative of syphilis Because of their great sensitivity, particularly in the late stages of the disease, these tests are also of value when there is clinical evidence of syphilis but the nontreponemal serologic test for syphilis is negative Treponemal tests are positive in most patients with primary syphilis and in almost all patients with secondary syphilis and like nontreponemal antigen tests, the specific treponemal antibody test may revert to negative with adequate therapy This is seen almost exclusively in initial infections in persons with primary syphilis In one study, 11% of individuals with a first episode of primary syphilis were seronegative by the FTAABS test at 1 year posttreatment and 24% were negative by 3 years Immunologic status may also affect antibody titers Seven percent of asymptomatic HIV-infected patients became seronegative after treatment, compared with 38% of symptomatic HIV-infected individuals The long-held belief that a positive treponemal test persists indefinitely is clearly not valid, and this test therefore cannot be used as a reliable marker of previous infection False-positive test results occur rarely in persons with systemic lupus erythematosus and in other disorders associated with increased levels of -globulins, malaria, leprosy, and other spirochetal infections It is note-
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