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VDRL test not recommended in primary syphilis/HIV coinfection
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Researchers from the University Hospital Zurich in Switzerland have found that the Venereal Disease Research Laboratory test was not sensitive enough and should not be recommended as a screening test for primary syphilis in those with HIV.
“Our data clearly support the ongoing paradigm shift towards a syphilis screening with treponemal-specific tests — known as reverse sequencing screening in the United States — as the non-treponemal Venereal Disease Research Laboratory (VDRL) test sensitivity was only 58% in primary syphilis cases,” Philipp Bosshard, PhD, of the department of dermatology at the University Hospital Zurich, told Infectious Disease News. “Furthermore, we suggest that in cases of suspected very early infection, a specific immunoglobulin M (IgM) capture enzyme-linked immunosorbent assay (ELISA) should be used in addition to other screening tests, as some primary syphilis cases were detected only with the IgM test.”
Philipp Bosshard
Bosshard and colleagues conducted a retrospective cohort study that included 264 patients with syphilis. They evaluated response to treatment measured by the VDRL test and the IgM ELISA.
At diagnosis, 42% of patients with primary syphilis had a negative VDRL test. After 3 months of treatment, 85% to 100% of patients with primary syphilis had a negative VDRL test, as did 76% to 89% of patients with secondary syphilis and 44% to 79% of patients with latent syphilis.
Overall, HIV did not have an effect on serological response to treatment. Patients with primary syphilis and CD4 counts of less than 500 cells/mcL had a slower treatment response on VDRL test. Secondary and latent syphilis were also associated with slower serological response of VDRL test and the ELISA test.
“Screening should be performed with treponemal-specific tests,” Bosshard said. “The suspicion of a very early infection should be communicated to the laboratory in order to use a specific IgM in addition to other screening tests. In most cases of primary and secondary syphilis treatment, response can be expected within 3 to 6 months. However, in latent syphilis, this might last up to 2 years.”
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