The rising number of syphilis cases in the United States in recent years has led to an uptick in ocular syphilis – a manifestation of the disease affecting the eyes. Given the trend, the CDC released an update in February 2024, outlining the most effective strategies to diagnose or dismiss syphilis. This update, which is the result of a comprehensive review of the existing literature, offers guidelines for identifying syphilis through antibodies present in the serum or cerebrospinal fluid, direct observation, or histologic assessment.
The most reliable method for testing syphilis remains serology, which involves both nontreponemal and treponemal serologic tests. These tests are designed to detect Treponema pallidum subsp. pallidum bacteria – the organism responsible for syphilis. Nontreponemal tests, also known as lipoidal antigen tests, identify the reaction of a patient’s serum to non-specific antigens associated with a syphilis infection. In contrast, treponemal tests detect antibodies specific to T. pallidum. As these antibodies are usually present for life, treponemal tests are used primarily for detecting the disease rather than monitoring it.
Direct visualization of T. pallidum is possible through methods like darkfield microscopy, immunofluorescence, and immunohistochemistry. However, these techniques are not as relevant in an ophthalmology clinic because ocular syphilis doesn’t typically present exudative lesions that can be sampled.
It’s vital to conduct systematic syphilis testing in patients showing ocular conditions that could be caused by syphilis. The CDC recommends a combination of nontreponemal and treponemal tests for such patients. The traditional testing algorithm starts with a nontreponemal test, which, if positive, is confirmed with a treponemal test. Conversely, in populations with a high prevalence of syphilis, the reverse algorithm is more appropriate, starting with a treponemal test followed by a nontreponemal test. In situations where the results are contradictory, a second treponemal test is suggested.
Healthcare providers should ensure that the laboratories they work with follow the latest CDC guidelines, and they should confirm the sequence of tests aligns with these guidelines. Once syphilis is diagnosed, RPR or VDRL tests can be used to track the progression of the disease.
Please remember, if you or someone you know is experiencing eye problems, don’t hesitate to contact me, Dr. Navin Kumar Gupta, at the Shankar Netrika Eye Centre in Mumbai. As an experienced ophthalmologist, I can provide a thorough examination and recommend appropriate treatment. You can find more information about my clinic and services on my website – https://shankarnetrika.com/. Get in touch today to ensure your eyes get the care they need.
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