Can the VDRL test pick up HIV

syphilis

Abstract

Syphilis (syphilis) is a disease that can be transmitted mainly through sexual intercourse (pathogen: Treponema pallidum) with a stage-like, often chronic course. After initially local manifestation as a primary effect ("ulcus durum", "hard chancre"), the secondary stage results in the formation of a polymorphic rash and certain condylomas in the genital region ("condylomata lata"). Between this stage II and the later stages III and IV, a latency period is typical, which can last for months to years and in which spontaneous healing is also possible. In the later stages, characteristic granulomas ("gums") can develop and neurological (neurosyphilis) and cardiovascular involvement with massive damage to the organ systems concerned can occur. Since the course in all phases is very diverse, syphilis can only be clinically differentiated from various other diseases with difficulty, especially in the later stages, which is why a detailed diagnosis is crucial.

Diagnostics is extremely complex and, in addition to direct pathogen detection (e.g. in dark field microscopy), includes numerous serological tests (including TPHA as a search test, VDRL and IgM antibodies as activity tests). If the disease is proven, the therapeutic gold standard is the administration of penicillin. The disease represents a special situation for an expectant mother, as infection of the unborn child is possible in the 4th or 5th month of pregnancy and can lead to serious damage.

Epidemiology

  • Gender: ♂> ♀ (14: 1)
  • Frequency: On average, 5–20 cases per 100,000 inhabitants are reported in Germany
  • Age distribution: highest incidence between 20 and 49 years

Unless otherwise stated, the epidemiological data refer to Germany.

etiology

Treponemas (especially in stages I / II) are highly infectious! Sexual intercourse with a partner suffering from active syphilis leads to an infection in about 30% of cases!

classification

Classification according to stages

stagesynonymdescriptionTypical clinical manifestationsPathophysiology / histology
Primary syphilisLues I

Local reaction with mostly scarred healing

  • Penetration of the pathogen through micro-lesions of the (mucous) skin with local colonization around the entry portal, which leads to a painless ulcus durum
  • The pathogen then spreads to the regional lymph nodes, which also results in painless swelling
Secondary syphilisLues II

Systemic spread of the pathogen with an immunological counter-reaction

Latent syphilisLues latensMonths, years or lifelong rest
  • Symptom-free persistence of pathogens in the organism for months or years
  • Both spontaneous healing and reactivation of the disease are possible
Tertiary syphilisLues III

Late inflammatory (granulomatous) reaction to the pathogen

Quaternary syphilisLues IVInfection of the CNS by the pathogen with an immunological counter-reaction
  • The pathogen enters the CNS, particularly in the case of immunodeficiency (e.g. co-infection with HIV). However, it is not the direct pathogen, but primarily the inflammatory reaction of the meninges and vessels (with ischemia) that triggers the clinical symptoms.
In German-speaking countries, regardless of the symptoms, syphilis is also divided into early syphilis (up to 1 year after the time of infection) and late syphilis (all later phases of the disease + unknown time of infection). The reason is that if the infection lasts more than a year, a longer duration of therapy is recommended (→ see therapy).

Symptoms / clinic

incubation period

Primary syphilis

  • Synonyms: Lues I, primary stage
  • General symptoms: Regional swelling of the lymph nodes
  • Specific symptoms
    • Primary effect ("Ulcus durum", "hard chancre"): Painless, hard ulcer with hardened edge area → Scarred healing usually within 6 weeks

Secondary syphilis

  • Synonyms: Lues II, secondary stage
  • General symptoms
  • Specific symptoms
    • Polymorphic exanthema / enanthemum
      • Typical
        • Start: Macular exanthema on trunk and flanks, later also on the palms and feet
        • After a few days: papular rash
        • Usually no itching
      • Plaques muqueuses: Papulopustular enanthemums in the mouth and nose area
      • Papulosquamous rash on the palm and hairline
    • More lesions
    • Special form in the secondary stage: Lues maligna
      • Severe course with immunosuppression (e.g. with simultaneous HIV infection)
      • Multiple ulcerations

Latent syphilis

  • Synonyms: stage of latency, syphilis latens
  • Symptoms: No clinical symptoms despite positive serology

Tertiary syphilis

  • Synonyms: Lues III, tertiary stage
  • Specific symptoms
    • Gums: appearance of granulomatous tissue changes with a tendency to ulceration
      • Skin: Subcutaneous infiltrates that secrete an inflammatory secretion when ulcerated.
      • Other organs: gums can occur on every organ. If the CNS is involved, one speaks of stage IV or neurosyphilis
    • Cardiovascular syphilis: aortic aneurysm, mesaortitis

Quaternary syphilis

Diverse course of syphilis with imitation of many other diseases possible

Diagnosis

Direct pathogen detection

  • Indication: Suspicion of an early stage of syphilis where samples can be obtained (e.g. weeping ulcus durum)
  • Consequence: A negative result does not rule out syphilis. If the result is positive, there is a need for therapy
  • Most commonly used procedures
    • Dark field microscopy, possibly in combination with immunofluorescence methods
    • PCR