Indian J Sex Transm Dis Indian J Sex Transm Dis
Official Publication of the Indian Association for the Study of Sexually Transmitted Diseases
Indian J Sex Transm Dis
The Journal | Search | Ahead Of Print | Current Issue | Archives | Instructions | Subscribe | Login    Users online: 224   Home Email this page Print this page Bookmark this page Decrease font size Default font size Increase font size

  Table of Contents  
Year : 2014  |  Volume : 35  |  Issue : 1  |  Page : 70-71

Making serological diagnosis of syphilis more accurate

1 Department of Microbiology, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India
2 Department of Dermatology and Venereology, Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka, India

Date of Web Publication13-May-2014

Correspondence Address:
S R Prasad
Department of Microbiology, Sri Devaraj Urs Medical College, Tamaka, Kolar 563 101, Karnataka
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0253-7184.132407

Rights and Permissions


How to cite this article:
Archana B R, Prasad S R, Beena P M, Okade R. Making serological diagnosis of syphilis more accurate. Indian J Sex Transm Dis 2014;35:70-1

How to cite this URL:
Archana B R, Prasad S R, Beena P M, Okade R. Making serological diagnosis of syphilis more accurate. Indian J Sex Transm Dis [serial online] 2014 [cited 2022 Oct 5];35:70-1. Available from:


We read with interest the paper "Evaluation of the usefulness of Treponema pallidum hemagglutination test in the diagnosis of syphilis in weak reactive Venereal Disease Research Laboratory sera" by Bala et al., which was recently published in your journal. They have reported that among 80 sera detected to be reactive in the Venereal Disease Research Laboratory (VDRL) test, 68 (85%) had titers of <8. [1] When these sera were subjected to Treponema pallidum hemagglutination (TPHA) test, it was found that 59 (86.8%) of them showed positivity. The biological false positivity (BFP) rate in their study was quite low (0.2%). To improve the accuracy of detection and confirmation of syphilis, the authors recommend that all sera reactive in VDRL (a reaginic test) regardless of their titer should be confirmed by TPHA (a treponemal test); this recommendation has also been made by World Health Organization. [2]

Between 2008 and 2011 we screened 11,478 serum samples, by both rapid plasma reagin (RPR) test (RPR, which is a reaginic test similar to VDRL test) and TPHA at Sri Devaraj Urs Medical College, Kolar, Karnataka. RPR test was performed using the RPR Kit of Span Diagnostics Ltd., India, and TPHA by the TPHA Kit of Plasmatec Laboratory products, UK. The findings are presented in [Table 1].
Table 1: Seropositivity of syphilis in different the groups of patients

Click here to view

In our study, we found that 136 (1.18%) of the 11,478 sera screened for syphilis were reactive in RPR test. The seropositivity among pregnant women in our study was 1.08% which was higher than the seropositivity of 0.96% seen among patients suspected of syphilis. We attribute this unusual finding to the large number of patients with different gynecological disorders screened to rule out syphilis. This seropositivity rate is comparable to that of 1%, observed among referrals from the Outpatient Departments and wards, reported in a recent study from Delhi. [3]

In our study, all the 136 sera reactive in RPR were also positive in TPHA. Thus in our study no BFP were detected. Above all, most importantly, similar to the observations made by Bala et al., we also found that a sizable proportion of reactive sera showed a titer of <8 in the reaginic test. [1]

After treatment of syphilis usually reaginic tests become non-reactive in 1-2 years. If the reaginic test is reactive in low titers it may mean delayed institution of treatment or past untreated syphilis. It may indicate failure of treatment to eradicate treponemes from the body. [4]

We strongly recommend that all patients whose sera are reactive in the reaginic test, irrespective of titer, should be confirmed by TPHA. Those found positive in both the tests should be treated with penicillin, unless they give a definitive history of such treatment in the past. [5] We feel that this strategy in treatment is more beneficial to the patient and reduces the complications of untreated syphilis.

   References Top

1.Bala M, Toor A, Malhotra M, Kakran M, Muralidhar S, Ramesh V. Evaluation of the usefulness of Treponema pallidum hemagglutination test in the diagnosis of syphilis in weak reactive Venereal Disease Research Laboratory sera. Indian J Sex Transm Dis 2012;33:102-6.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.World Health Organization. Treponemal infections. Technical Reports Series 674. Geneva: WHO; 1982.  Back to cited text no. 2
3.Bala M, Singh V, Muralidhar S, Ramesh V. Assessment of reactivity of three treponemal tests in non-treponemal non-reactive cases from sexually transmitted diseases clinic, antenatal clinic, integrated counselling and testing centre, other different outdoor patient departments/indoor patients of a tertiary care centre and peripheral health clinic attendees. Indian J Med Microbiol 2013;31:275-9.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.Sparling FP, Swartz MN, Musher DM, Healy BP. Clinical manifestations of syphilis. In: Holmes KK, Sparling FP, Stamm WE, Piot P, Wasserheit JN, Corey L et al., editors . Sexually Transmitted Diseases. 4 th Ed. New York: The McGraw-Hill Companies Inc.; 2008. p. 678.  Back to cited text no. 4
5.Case definitions for infectious conditions under public health surveillance. Centers for Disease Control and Prevention. MMWR Recomm Rep 1997;46:1-55.  Back to cited text no. 5


  [Table 1]

This article has been cited by
1 Asian guidelines for syphilis
Nikhil Mehta, Neetu Bhari, Somesh Gupta
Journal of Infection and Chemotherapy. 2022;
[Pubmed] | [DOI]
2 Performance of Chemiluminiscence Assay using Reverse Algorithm for Syphilis Screening in Blood Donors
Mamata Kale, Subhashish Das, Mahesh Venkatesha, Parvangada Madappa Beena
Journal of Pure and Applied Microbiology. 2018; 12(4): 2253
[Pubmed] | [DOI]


Print this article  Email this article


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (378 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

    Article Tables

 Article Access Statistics
    PDF Downloaded110    
    Comments [Add]    
    Cited by others 2    

Recommend this journal