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 ~  Abstract
 ~  Materials and Me...
 ~  Results
 ~  Discussion
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Year : 2003  |  Volume : 21  |  Issue : 2  |  Page : 118-120
 

Screening by VDRL test to detect hidden cases of syphilis


Department of Microbiology, Pt. BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana - 124 001, India

Correspondence Address:
Department of Microbiology, Pt. BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana - 124 001, India

 ~ Abstract 

A total of 59,450 sera from January 1996 to December 2000 were subjected to VDRL testing. Overall VDRL positivity rate was 3.2% and downward trend was observed in the recent years, 1999 and 2000. Majority of the samples were from Gynaecology department, out of which 1.57% were VDRL positive. Out of 30,045 samples from antenatal females, 517(1.47%) were positive, while 304(1.8%) were positive out of 16,980 samples obtained from couples. Out of 304 samples from couples found positive, 17.4% wives had titre >R16; 27.9% wives had titre R1 to R8, out of which 15.3% husbands had titre of >R16. Also, 166 wives with nonreactive VDRL had 19.3% husbands with titre > R16. Thus, couple VDRL test plays an important role in detection of hidden cases of syphilis in the community and early detection and treatment of such cases will further reduce the perinatal morbidity and mortality.

How to cite this article:
Gupta N, Gautam V, Sehgal R, Gill P S, Arora D R. Screening by VDRL test to detect hidden cases of syphilis. Indian J Med Microbiol 2003;21:118-20


How to cite this URL:
Gupta N, Gautam V, Sehgal R, Gill P S, Arora D R. Screening by VDRL test to detect hidden cases of syphilis. Indian J Med Microbiol [serial online] 2003 [cited 2019 Sep 17];21:118-20. Available from: http://www.ijmm.org/text.asp?2003/21/2/118/7988


In developing countries like ours, screening for syphilis during pregnancy is done by VDRL test. Screening of asymptomatic persons with the VDRL test, followed by treponemal test confirmation on positive sera is recommended for all pregnant women.[1] Positive VDRL reaction is an important cause of perinatal mortality due to infection. Prevention, timely detection and treatment of this causative factor will reduce these perinatal deaths.[2] Sensitivity of VDRL is high in secondary and early latent syphilis, while specificity is high in healthy persons as compared to ill persons.[1] Thus we undertook this study to compare the detection of hidden cases of syphilis in the community by routine VDRL test during antenatal screening for syphilis for both husband and wife as compared to wife alone.

 ~ Materials and Methods Top

A total of 59,450 serum samples obtained from patients attending Post Graduate Institute of Medical Sciences, Rohtak, Haryana during the period Jan. 1996 to Dec. 2000 were subjected to VDRL test. VDRL testing was done using standard method and quantitative VDRL test was done for positive samples.[3] The VDRL antigen used was obtained from Serology laboratory, Kolkata.

 ~ Results Top

Out of 59,450 samples obtained during the five year period, 1905 (3.2%) samples were VDRL reactive. VDRL reactivity fell from 3.9% in 1997 to 2.6% to 2.7% in the years 1999 and 2000 respectively. VDRL reactivity in samples obtained from Gynaecology and Obstetrics, Dermatology, and Medicine and Surgery departments was 1.57%, 16.16% and 8.4% respectively [Table - 1].
A total of 52,045 samples were obtained from attendees of antenatal clinic. Of the 35,065 antenatal females tested, 517 (1.47%) were VDRL reactive. Also we tested 8,490 couples (i.e. 16,980 samples), out of which 304 (1.8%) samples were VDRL reactive. [Table - 2] shows the comparison of titres of husband and wife when either one or both were VDRL reactive. [Table - 3] shows the titres of husbands when their wives either tested reactive or non-reactive with titres R1 to R8 or VDRL titre >16. Out of 304 samples, 53 (17.4%) wives had titre >R16. Eighty five (27.9%) wives had titres R1 to R8 out of which 13 (15.3%) husbands had titre >R16. Also 166 wives with non - reactive VDRL had 32 (19.3%) husbands with titre >R16 [Table - 3].

 ~ Discussion Top

VDRL test is a standardised, economical, sensitive and easy to perform test and we have extensive experience with its use. Therefore, it is a preferred serological test. Current recommendations are to screen at the first prenatal visit and again at 28 week gestation and at delivery in women from high risk population.[3] In Haryana, a five year study revealed overall VDRL reactivity to be 3.2%. Maximum VDRL reactivity (16.2%) was reported from Dermatology department, with a low reactivity being reported in pregnant women (1.57%).
Serological diagnosis of syphilis requires sequential reactivity of a serum specimen in each of the two tests; usually a non - treponemal test is initially done using cardiolipin - lecithin - cholesterol antigen to detect cross lipid antibodies produced in response to infection with Treponema pallidum. If reactive, the non - treponemal test result is confirmed by more specific treponemal antigen based test e.g. FTA-ABS test.[5] An initial VDRL titre of less than R16 should arise a significant doubt about the diagnosis as it may be a biological false positive reaction as seen in pregnancy, acute febrile illness, after immunization, systemic lupus erythematosis, rheumatoid arthritis and other autoimmune diseases.[5] Therefore in our study, we considered VDRL titre R1-R8 as doubtful and titre >R16 as positive.[6] Our study clearly detected 166 (54.9%) husbands who were VDRL reactive when their wives were VDRL non - reactive. Out of these 166 reactive husbands, 134 (80.7%) had titre R1 to R8 and 32 (19.3%) had a significant titre of >R16. When wife's titre was between R1 to R8 then husband's VDRL titre was >R16 in 13 (15.3%) cases, R1 to R8 in 33 (38.8%) and non-reactive in 39 (45.9%) cases. When wife's titre was >R16, then husband's titre was also >R16 in 19 (37.7%) cases, R1 to R8 in 17 (33.3%) and non-reactive in 15 (29.4%) cases.
Thus, if only antenatal females are examined and if their husbands are syphilitic then women can acquire syphilis late in pregnancy after an initially negative serologic screening.[7] Also a woman who contracted infection once may be at increased risk of reinfection, especially if her sexual partner has not received treatment.[7] Thus VDRL testing of both husband and wife during antenatal screening is of special value in the diagnosis, treatment and prevention of syphilis in the newborn. 

 ~ References Top

1.Hart G. Syphilis tests in diagnostic and therapeutics decision making. Annals of Internal Medicine 1986;104:368-376.  Back to cited text no. 1    
2.Vaidya PR, Patel VS. Pregnancy outcome in VDRL positive women. The Indian Practitioner 1987;9:671-674.  Back to cited text no. 2    
3.Young H. In: Mackie and Mc Cartney Practical Medical Microbiology, 13th ed. Vol. 2, Chapter 40: 655-666.  Back to cited text no. 3    
4.Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines. MMWR 1989;38(suppl):1-43.  Back to cited text no. 4    
5.Rampalo AM, Cannon RO, Quinn TC, Hook EW. Association of biologic false positive reaction for syphilis with Human Immunodeficiency Virus Infection. J Infectious Dis 1992;165:1124-1126.  Back to cited text no. 5    
6.Musher DM, Baughn RE. In: Infectious Diseases. (WB Saunders Company), 2nd edition 1998, Chapter 112: 980-985.  Back to cited text no. 6    
7.Klass PE, Brown ER, Pelton SI. The incidence of prenatal syphilis at the Boston City Hospital, A comparison across four decades. Paediatrics 1994;94:24-28.  Back to cited text no. 7    
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2004 - Indian Journal of Medical Microbiology
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