Syphilis: New Diagnostic Directions

Rathlev T. Haemagglutinatin tests utilizing antigens from pathogenic and apathogenic Treponema pallidum . WHO/VDT/RES 1965;77,65.

Rathlev T. Haemagglutination test utilizing pathogenic Treponema pallidum for the sero-diagnosis of syphilis. Br J Vener Dis 1967;43:181–5.

Young H Henrichsen C Robertson DHH. Treponema pallidum haemagglutination test as a screening procedure for the diagnosis of syphilis. Br J Vener Dis 1974;50:341–6.

World Health Organization. Treponemal infections. Technical report series 674. Geneva: World Health Organization, 1982.

Robertson DHH McMillan A Young H. Diagnosis of syphilis. In: Clinical practice in sexually transmissible diseases. Edinburgh: Churchill Livingstone, 1989:118–35.

Holland EF O'Mahony CP. Is it time to review antenatal screening for syphilis? Br J Obstet Gynaecol 1989;96:1005–6.

International Forum. Does it make sense for blood transfusion services to continue the time-honored syphilis screening with cardiolipin antigen? Vox Sang 1981;41:183–92.

Penn CW. Pathogenicity and molecular biology of treponemes. Rev Med Microbiol 1991;2:68–75.

Isaacs RD Radolf JD. Molecular approaches to improved syphilis serodiagnosis. Serodiag Immunotherapy Infect Dis 1989;3:299–306.

Plettenberg A Bahlmann W Stoehr A Meigel W. [Clinical and serological findings of syphilis in HIV-infected patients]. Dtsch Med Wochenschr 1991;116:968–72.

Wooldridge WE. Syphilis. A new visit from an old enemy. Postgrad Med 1991;89:193–6, 199–20.

Melvin SY. Syphilis. Resurgence of an old disease. Prim Care 1990;17:47–57.

Musher DM Hamill RJ Baughn RE. Effect of human immunodeficiency virus (HIV) infection on the course of syphilis and on the response to treatment. Ann Intern Med 1990;113:872–81.

Hutchinson CM Hook EW. Syphilis in adults. Med Clin North Am 1990;74:1389–416.

Rufli T. Syphilis and HIV infection. Dermatologica 1989;179:113–17.

Matlow AG Rachlis AR. Syphilis serology in human immunodeficiency virus-infected patients with symptomatic neurosyphilis: Case report and review. Rev Infect Dis 1990;12:703–7.

Hook EW. Syphilis and HIV infection. J Infect Dis 1989;160:530–4.

Johns DR Tierney M Felsenstein D. Alteration in the natural history of neurosyphilis by concurrent infection with the human immunodeficiency virus. N Engl J Med 1987;316:1569–72.

Hicks CB Benson PM Lupton GP Tramont EC. Seronegative secondary syphilis in a patient infected with the human immunodeficiency virus (HIV) with Kaposi sarcoma. A diagnostic dilemma. Ann Intern Med 1987;107:492–5 (erratum 1987;107:946).

Johnson PD Graves SR Stewart L Warren R Dwyer B Lucas CR. Specific syphilis serological tests may become negative in HIV infection. AIDS 1991;5:419–23.

Lukehart SA Hook EW Baker-Zander SA Collier AC Critchlow CW Handsfield HH. Invasion of the central nervous system by Treponema pallidum: implications for diagnosis and treatment. Ann Intern Med 1988;109:855–62.

Continuing increase in infectious syphilis—United States. Arch Dermatol 1988;124:509–10.

From the Centers for Disease Control. Primary, secondary syphilis-U.S., 1981–1990. JAMA 1991;265:2940.

Tang A Barlow D. Resurgence of heterosexually acquired early syphilis in London (letter). Lancet 1989;ii:166–7.

van den Hoek JA van der Linden MM Coutinho RA. Increase of infectious syphilis among heterosexuals in Amsterdam: Its relationship to drug use and prostitution. Genitourin Med 1990;66:31–2.

Marchitto KS Selland-Grossling CK Norgard MV. Molecular specificities of monoclonal antibodies directed against virulent Treponema pallidum . Infect Immun 1986;51:168–76.

Moskophidis M Muller F. Monoclonal antibodies to immunodominant surface-exposed protein antigens of Treponema pallidum . Eur J Clin Microbiol 1985;4:473–7.

Lukehart SA Tarn MR Horn J Baker-Zander SA Holmes KK Nowinski RC. Characterization of monoclonal antibodies to Treponema pallidum . J Immunol 1985;134:585–92.

Norgard MV Selland CK Kettman JR Miller JN. Sensitivity and specificity of monoclonal antibodies directed against antigenic determinants of Treponema pallidum Nichols in the diagnosis of syphilis. J Clin Microbiol 1984;20:711–17.

Lukehart SA Baker-Zander SA. Diagnostic potential of monoclonal antibodies against Treponema pallidum. In: Young H McMillan A , eds. Immunological diagnosis of sexually transmitted diseases. New York: Marcel Dekker, 1988:213–47.

Wicher K van Embden JD Schouls LM Zabek J Jakubowski A Wicher V. Immunogenicity of three recombinant Treponema pallidum antigens examined in guinea pigs. Int Arch Allergy Appl Immunol 1989;89:128–35.

Schouls LM Ijsselmuiden OE Weel J van Embden JD. Overproduction and purification of Treponema pallidum recombinant-DNA-derived proteins TmpA and TmpB and their potential use in serodiagnosis of syphilis. Infect Immun 1989;57:2612–23.

Stamm LV Dallas WS Ray PH Bassford PJ Jr. Identification, cloning, and purification of protein antigens of Treponema pallidum . Rev Infect Dis 1988;10(suppl 2):S403–S407.

Young H Moyes A McMillan A Robertson DHH. Screening for treponemal infection by a new enzyme immunoassay. Genitourin Med 1989;65:72–8.

Dettori G Grillo R Mora G Cavalli A Alinovi A Chezzi C Sanna A. Evaluation of Western immunoblotting technique in the serological diagnosis of human syphilitic infections. Eur J Epidemiol 1989;5:22–30.

Dobson SR Taber LH Baughn RE. Recognition of Treponema pallidum antigens by IgM and IgG antibodies in congenitally infected newborns and their mothers. J Infect Dis 1988;157:903–10.

Lewis LL Taber LH Baughn RE. Evaluation of immunoglobulin M western blot analysis in the diagnosis of congenital syphilis. J Clin Microbiol 1990;28:296–302.

Hay PE Clarke JR Robinson D Taylor Goldmeier D. Detection of treponemal DNA in the CSF of patients with syphilis and HIV infection using the polymerase chain reaction. Genitourin Med 1990;66:428–32.

Burstain JM Grimprel E Lukehart SA Norgard MV Radolf JD. Sensitive detection of Treponema pallidum by using the polymerase chain reaction. J Clin Microbiol 1991;29:62–9.

Noordhoek GT Wolters EC de Jonge MEJ van Embden JD. Detection by polymerase chain reaction of Treponema pallidum DNA in cerebrospinal fluid from neurosyphilis patients before and after antibiotic treatment. J Clin Microbiol 1991;29:1976–84.

Greenblatt RM Lukehart SA Plummer FA Genital ulceration as a risk factor for human immunodeficiency virus infection. AIDS 1991;2:47–50.

Stamm WE Handsfield HH Rompalo AM Ashley RL Roberts PL Corey L. The association between genital ulcer disease and acquisition of HIV infection in homosexual men. JAMA 1988;260:1429–33.

Holmberg SD Horsburgh CR Jr Ward JW Jaffe HW. Biologic factors in the sexual transmission of human immunodeficiency virus. J Infect Dis 1989;160:116–25.

Tseng CT Sell S. Protracted Treponema pallidum-induced cutaneous chancres in rabbits infected with human T-cell leukemia virus type I. AIDS Res Hum Retroviruses 1991;7:323–31.

Recommendations for diagnosing and treating syphilis in HIV-infected patients. MMWR 1988;37:600–2, 607–8.

Strobel M Beauclair P Lacave J. Seronegative syphilis in AIDS (letter). Presse Med 1989;18:1440.

Hicks CB. Syphilis and HIV infection. Dermatol Clin 1991;9:493–501.

Sindrup JH Weismann K Wantzin GL. Syphilis in HTLV-III infected male homosexuals. AIDS Res 1986;2:285–8.

Hutchinson CM Rompalo AM Reichart CA Hook EW. Characteristics of patients with syphilis attending Baltimore STD clinics. Multiple high-risk subgroups and interactions with human immunodeficiency virus infection. Arch Intern Med 1991;151:511–16.

Terry PM Page ML Goldmeier D. Are serological tests of value in diagnosing and monitoring response to treatment of syphilis in patients infected with human immunodeficiency virus? Genitourin Med 1988;64:219–22.

Telzak EE Greenberg MS Harrison J Stoneburner RL Schultz S. Syphilis treatment response in HW-infected individuals. AIDS 1991;5:591–5.

Haas JS Bolan G Larsen SA Clement MJ Bacchetti P Moss AR. Sensitivity of treponemal tests for detecting prior treated syphilis during human immunodeficiency virus infection. J Infect Dis 1990;162:862–6.

Sjovall P Flamholc L Kroon BM Bredberg A. HIV infection and loss of treponemal test reactivity. Acta Derm Venereal (Stockh) 1991;71;458.

Glatt AE Stoffer HR Forlenza S Altieri RH. High-titer positive nontreponemal tests with negative specific treponemal serology in patients with HTV infection and/or intravenous substance use. J Acquir Immune Defic Syndr 1991;4:861–4.

Shulkin D Tripoli L Abell E. Lues maligna in a patient with human immunodeficiency virus infection. Am J Med 1988;85:425–7.

Radolf JD Kaplan RP. Unusual manifestations of secondary syphilis and abnormal humoral immune response to Treponema pallidum antigens in a homosexual man with asymptomatic human immunodeficiency virus infection. J Am Acad Dermatol 1988;18:423–8.

Dawson S Evans BA Lawrence AG. Benign tertiary syphilis and HIV infection. AIDS 1988;2:315–16.

Bari MM Shulkin DJ Abell E. Ulcerative syphilis in acquired immunodeficiency syndrome: A case of precocious tertiary syphilis in a patient infected with human immunodeficiency virus. J Am Acad Dermatol 1989;21:1310–12.

Berger JR. Neurosyphilis in human immunodeficiency virus type 1-seropositive individuals. A prospective study. Arch Neurol 1991;48:700–2.

Berry CD Hooton TM Collier AC Lukehart SA. Neurologic relapse after benzathine penicillin therapy for secondary syphilis in a patient with HIV infection. N Engl J Med 1987;316:1587–9.

Zambrano W Perez GM Smith JL. Acute syphilitic blindness in AIDS. J Clin Neurol Ophthalmol 1987;7:1–5.

Kleiner RC Najarian L Levenson J Kaplan HJ. AIDS complicated by syphilis can mimic uveitis and Crohn's disease. Case report. Arch Ophthalmol 1987;105:1486–7.

Carter JB Hamill RJ Matoba AY. Bilateral syphilitic optic neuritis in a patient with a positive test for HIV. Case report. Arch Ophthalmol 1987;105:1485–6.

Stoumbos VD Klein ML. Syphilitic retinitis in a patient with acquired immunodeficiency syndrome-related complex. Am J Ophthalmol 1987;103:103–4.

Passo MS Rosenbaum JT. Ocular syphilis in patients with human immunodeficiency virus infection. Am J Opthalmol 1988;106:1–6.

Tamesis RR Foster CS. Ocular syphilis. Ophthalmology 1990;97:1281–7.

Smego RA Jr Moreadith RW Kleist PC Granger DL. Secondary syphilis masquerading as AIDS in a young gay male. N C Med J 1984;45:253–4.

Calza AM Kinloch S Mainetti C Salomon D Saurat JH. Primary human immunodeficiency virus infection mimicking syphilis. J Infect Dis 1991;164:615–16.

Rolfs RT Nakashima AK. Epidemiology of primary and secondary syphilis in the United States, 1981 through 1989. JAMA 1990;264:1432–7.

Handsfield HH Schwebke J. Trends in sexually transmitted diseases in homosexually active men in King County, Washington, 1980–1990. Sex Transm Dis 1990;17:211–15.

Short SL Stockman DL Wolinsky SM Trupei MA Moore J Reichman RC. Comparative rates of sexually transmitted diseases among heterosexual men, homosexual men, and heterosexual women. Sex Transm Dis 1984;11:271–4.

Mindel A Tovey SJ Williams P. Primary and secondary Syphilis, 20 years' experience. 1. Epidemiology. Genitourin Med 1987;63:361–4.

Johnson AM Gill ON. Evidence for recent changes in sexual behaviour in homosexual men in England and Wales. Philos Trans R Soc Lond [Biol] 1989;325:153–61.

French PD Davis J Goldmeier D. Syphilis among heterosexuals (Letter). Genitourin Med 1990;66:304–5.

von Krogh G Hellstrom L Bottiger M. Declining incidence of syphilis among homosexual men in Stockholm (Letter). Lancet 1986;ii:920–1.

Poulsen A Ullman S. AIDS-induced decline of the incidence of syphilis in Denmark. Acta Derm Venereol (Stockh) 1985;65:567–9.

Lee CB Brunham RC Sherman E Harding GK. Epidemiology of an outbreak of infectious syphilis in Manitoba. Am J Epidemiol 1987;125:277–83.

From the Centers for Disease Control. Epidemic early syphilis—Escambia County, Florida, 1987 and July 1989-June 1990. JAMA 1991;265:2782.

Alternative case-finding methods in a crack-related syphilis epidemic-Philadelphia. MMWR 1991;40:77–80.

Relationship of syphilis to drug use and prostitution-Connecticut and Philadelphia, Pennsylvania. Arch Dermatol 1989;125:169–70.

Handsfield HH. Recent developments in STDs: I. Bacterial diseases. Hasp Pract (Off Ed) 1991;26:47–56.

Primary and secondary syphilis—United States, 1981–1990. MMWR 1991;40:314–15, 321–3.

Progress toward achieving the 1990 Objectives for the Nation for sexually transmitted diseases. MMWR 1990;39:53–7.

Congenital syphilis-New York City, 1986–1988. MMWR 1989;38:825–9.

Sexually transmitted disease in Britain: 1985–6. Public Health Laboratory Service Communicable Disease Surveillance Centre. Genitourin Med 1989;65:117–21.

Young H Penn CW. Syphilis, yaws and pinta. In: Smith GR Easmon CSF , eds. Topley and Wilson's principals of bacteriology, virology and immunology. Kent: Edward Arnold, 1990:588–604.

Daniels KC Ferneyhaugh HS. Specific direct fluorescent antibody detection of Treponema pallidum . Health Lab Sci 1977;14:164–71.

Luger A. Diagnosis of syphilis. Bull World Health Organ 1981;59:647–55.

Hook EW Roddy RE Lukehart SA Horn J Holmes KK Tarn MR . Detection of Treponema pallidum in lesion exudate with a pathogen-specific monoclonal antibody. J Clin Microbiol 1985;22:241–4.

McNeil K Stewart SS Fuller SA Zawydiwski R Wendel GD. An enzyme immunoassay for Treponema pallidum antigen. Annual Meeting of the American Society for Microbiology 1990 (abstract).

From the MMWR. Recommendations for diagnosing and treating syphilis in HIV-infected patients. Arch Dermatol 1989;125:15–16.

Ito F Hunter EF George RW Swisher BL Larsen SA. Specific immunofluorescence staining of Treponema pallidum in smears and tissues. J Clin Microbiol 1991;29:444–8.

Chung KY Lee MG Chon CY Lee JB. Syphilitic gastritis: Demonstration of Treponema pallidum with the use of fluorescent treponemal antibody absorption complement and immunoperoxidase stains. J Am Acad Dermatol 1989;21:183–5.

Heid E Lux C. Battistelli [Identification of treponemes in paraffin-embedded sections, using an anticomplement immunofluorescence technique]. Ann Pathol 1991;11:128–31.

Riviere GR Wagoner MA Zander SA Baker Identification of spirochetes related to Treponema pallidum in necrotizing ulcerative gingivitis and chronic periodontitis. N Engl J Med 1991;325:539–43.

Riviere GR Weisz KS Simonson LG Lukehart SA. Pathogen-related spirochetes identified within gingival tissue from patients with acute necrotizing ulcerative gingivitis. Infect Immun 1991;59:2653–7.

Gjestland T. The Oslo study of untreated syphilis—an epidemiologic investigation of the natural course of untreated syphilis based on a study of the Boeck-Bruusgard material. Acta Derm Venereol 1955;35: Suppl 34.

Robertson DHH McMillan A Young H. Syphilis: Introduction. In: Clinical practice in sexually transmitted diseases. Edinburgh: Churchill Livingstone, 1989:108–17.

Luger AFH. Serological diagnosis of syphilis: Current methods. In: Young H McMillan A , eds. Immunological diagnosis of sexually transmitted diseases. New York: Marcel Dekker, 1988:249–74.

Baker-Zander SA Hook EW Bonin P Handsfield HH Lukehart SA. Antigens of Treponema pallidum recognized by IgG and IgM antibodies during syphilis in humans. J Infect Dis 1985;151:264–72.

Baker-Zander SA Roddy RE Handsfield HH Lukehart SA. IgG and IgM antibody reactivity to antigens of Treponema pallidum after treatment of syphilis. Sex Transm Dis 1986;13:214–20.

Wicher V Zabek J Wicher K. Pathogen-specific humoral response in Treponema pallidum-infected humans, rabbits, and guinea pigs. J Infect Dis 1991;163:830–6.

Young H Moyes A McMillan A Paterson J. Enzyme immunoassay for anti-treponemal IgG: Screening or confirmatory test? J Clin Pathol 1992;45:37–41.

Norris SJ Aldereete JF Axelsen NH Identity of Treponema pallidum subsp. pallidum polypeptides: correlation of sodium dodecylsulfate-polyacrylamide gel electrophoresis results from different laboratories. Electrophoresis 1987;8:77–92.

World Health Organization. Disease detection. In: Control of sexually transmitted diseases. Geneva: World Health Organization, 1985:33–40.

Jenum PA Ott T. Comparison of two syphilis antibody assays based on cardiolipin antigen. NIPH Ann 1991;14:3–9.

Samuels J Ernst A. Stat RPRs (Letter). Ann Emerg Med 1991;20:108–9.

Spangler AS Jackson J Fiumara NJ Warthin TA. Syphilis with a negative blood test reaction. JAMA 1964;189:113–16.

Feraru ER Aronow HA Lipton RB. Neurosyphilis in AIDS patients: Initial CSF VDRL may be negative. Neurology 1990;40:541–3.

Berkowitz K Baxi L Fox HE. False-negative syphilis screening: The prozone phenomenon, nonimmune hydrops, and diagnosis of syphilis during pregnancy. Am J Obstet Gynecol 1990;163:975–7.

Dorfman DH Glaser JH. Congenital syphilis presenting in infants after the newborn period. N Engl J Med 1990;323:1299–302.

Kim HW Shesser R Smith M. Testing for syphilis (letter). Ann Emerg Med 1989;18:802–3.

Pedersen NS Orum O Mouritsen S. Enzyme-linked immunosorbent assay for detection of antibodies to the venereal disease research laboratory (VDRL) antigen in syphilis. J Clin Microbiol 1987;25:1711–16.

Smythe LD Wiemers MA Sutherland CJ. An Elisa as a screening test for the detection of reagin antibody. Annual Scientific Meeting of the Australian Society for Microbiology. Australian Microbiologist 1991;12:366 (abstract).

Lukehart SA. Serologic testing after therapy for syphilis: Is there a test for cure? Ann Intern Med 1991;114:1057–8.

Anderson J Mindel A Tovey SJ Williams P. Primary and secondary syphilis, 20 years' experience. 3: Diagnosis, treatment, and follow up. Genitourin Med 1989;65:239–43.

Diggory P. Role of the Venereal Disease Research Laboratory test in the detection of syphilis. Br J Vener Dis 1983;59:8–10.

Puckett A Pratt G. Modification of the system of screening for antisyphilis antibodies in a blood transfusion centre featuring a miniaturisation of the Treponema pallidum haemagglutination assay. J Clin Pathol 1982;35:1349–52.

Veldkamp J Visser AM. Application of the enzyme-linked immunosorbent assay (ELISA) in the serodiagnosis of syphilis. Br J Vener Dis 1975;51:227–31.

Borobio MV Alvarez-Dardet C Gallardo RM. Evaluation of a solid-phase enzyme immunoassay in the diagnosis of syphilis. Eur J Sex Trans Dis 1985;2:231–3.

Stevens RW Schmitt ME. Evaluation of an enzyme-linked immunosorbent assay for treponemal antibody. J Clin Microbiol 1985;21:399–402.

Farshy CE Hunter EF Larsen SA Cerny EH. Double-conjugate enzyme-linked immunosorbent assay for immunoglobulins G and M against Treponema pallidum . J Clin Microbiol 1984;20:1109–13.

Lefevre JC Bertrand MA Bauriaud R. Evaluation of the Captia enzyme immunoassays for detection of immunoglobulins G and M to Treponema pallidum in syphilis. J Clin Microbiol 1990;28:1704–7.

Codd AA Sprott MS Narang HK Crone PB Turner RH. Competitive enzyme-linked immunosorbent assay for Treponema pallidum antibodies. J Med Microbiol 1988;26:153–7.

van Eijk RV Menke HE Tideman GJ Stolz E. Enzyme linked immunosorbent assays with Treponema pallidum or axial filament of T. phagedenis biotype Reiter as antigen: evaluation as screening tests for syphilis. Genitourin Med 1986;62:367–72.

Ijsselmuiden OE Schouls LM Stolz E Sensitivity and specificity of an enzyme-linked immunosorbent assay using the recombinant DNA-derived Treponema pallidum protein TmpA for serodiagnosis of syphilis and the potential use of TmpA for assessing the effect of antibiotic therapy. J Clin Microbiol 1989;27:152–7.

Duthie SJ King PA Yung GL Ma HK. Routine serological screening for syphilis during pregnancy—disposable anachronism or fundamental necessity? Aust N Z J Obstet Gynaecol 1990;30:29–31.

Clay JC. Antenatal screening for syphilis. BMJ 1989;299:409–10.

Gilbert GL. Congenital syphilis—should we worry? Med J Aust 1988;148:162–4.

Bowell P Mayne K Puckett A Entwistle C Selkon J. Serological screening tests for syphilis in pregnancy: Results of a five year study (1983–87) in the Oxford region. J Clin Pathol 1989;42:1281–4.

Pritchard RC Hudson BJ. Antenatal screening for syphilis editorial. Med J Aust 1989;151:363–4.

Williams K. Screening for syphilis in pregnancy: An assessment of the costs and benefits. Commun Med 1985;7:37–42.

Bindels PJ Postma MJ Peerbooms PG Coutinho RA van den Hoek JA. [Benefit of the serological screening program for syphilis in pregnant women in Amsterdam in the period 1985–1989]. Ned Tijdschr Geneeskd 1991;135:1319–22.

De Schryver A Meheus A. Syphilis and blood transfusion: A global perspective. Transfusion 1990;30:844–7.

Seidl S. Syphilis screening in the 1990s. Transfusion 1990;30:773–4.

Serrano J. [Syphilis and blood transfusion]. Sangre (Barc) 1991;36:211–15.

Corrado OJ Bowie PC Bagnall WE Waugh MA. The prevalence of positive serological tests for syphilis among elderly hospital patients. Age Ageing 1989;18:407–10.

Klaus MV Amarante L Beam TR Jr. Routine screening for syphilis is justified in patients admitted to psychiatric alcohol, and drug rehabilitation wards of the Veterans Administration Medical Center. Arch Dermatol 1989;125:1644–6.

Nieman EA. Neurosyphilis yesterday and today. J R Coll Physicians Lond 1991;25:321–4.

Boodhoo JA. Syphilis serology screening in a psychogeriatric population. Is the effort worthwhile? Br J Psychiatry 1989;155:259–62.

Waugh MA. Syphilis and the elderly. Genitourin Med 1991;67:434.

Gschnait F. Selected aspects of syphilis serology. Z Hautkr 1989;64:398–400.

Meurer M Braun-Falco O. Latent and manifest acquired syphilis—clinical aspects, diagnosis and therapy. Urologe [A] 1987;26:263–7.

Gormsen H. Postmortem diagnosis of syphilitic aortitis, including serological verification on postmortem blood. Forensic Sci Int 1984;24:51–6.

Case definitions for public health surveillance. MMWR 1990;39:34–8.

Hardy PH. Death knell for the Treponema pallidum immobilization test. Sex Transm Dis 1980;7:145–8.

Sprott MS Selkon JB Turner RH. Evaluation of the role of the Treponema pallidum immobilisation test in Britain. Br J Vener Dis 1982;58:147–8.

Rein MF Banks GW Logan LC Failure of the Treponema pallidum immobilization test to provide additional diagnostic information about contemporary problem sera. Sex Transm Dis 1980;7:101–5.

Beebe JL Nouri NJ. Comparative evaluation of commercial fluorescent treponemal antibody-absorbed test kits. J Clin Microbiol 1984;19:789–93.

Chronas G Moyes A Young H. Syphilis diagnosis: Screening by enzyme immunoassay and variation in fluorescent antibody absorbed (FTA-ABS) confirmatory test performance. Med Lab Sci 1992;49:50–5.

Hunter EF Russell H Farshy CE Sampson JS Larsen SA. Evaluation of sera from patients with Lyme disease in the fluorescent treponemal antibody-absorption test for syphilis. Sex Transm Dis 1986;13:232–6.

Larsen SA Farshy CE Pender BJ Adams MR Pettit DE Hambie EA. Staining intensities in the fluorescent treponemal antibody-absorption (FTA-Abs) test: Association with the diagnosis of syphilis. Sex Transm Dis 1986;13:221–7.

Carlsson B Hanson HS Wasserman J Brauner A. Evaluation of the fluorescent treponemal antibody-absorption (FTA-Abs) test specificity. Acta Derm Venereal (Stockh) 1991;71:306–11.

Moyer NP Hudson JD Hausler WJ Jr. Evaluation of the Bio-EnzaBead Test for Syphilis. J Clin Microbiol 1987;25:619–23.

Burdash NM Hinds KK Finnerry JA Manos JP. Evaluation of the syphilis Bio-EnzaBead assay for detection of treponemal antibody. J Clin Microbiol 1987;25:808–11.

Hensel U Wellensiek HJ Bhakdi S. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis immunoblotting as a serological tool in the diagnosis of syphilitic infections. J Clin Microbiol 1985;21:82–7.

Byrne RE Laska S Bell M Larson D Phillips J Todd J. Evaluation of a Treponema pallidum western immunoblot assay as a confirmatory test for syphilis. J Clin Microbiol 1992;30:115–22.

Brown ST Zaidi A Larsen SA Reynolds GH. Serological response to syphilis treatment. A new analysis of old data. JAMA 1985;253:1296–9.

Romanowski B Sutherland R Fick GH Mooney D Love EJ. Serologic response to treatment of infectious syphilis. Ann Intern Med 1991;114:1005–9.

Ijsselmuiden OE van der Sluis JJ Mulder A Stolz E Bolton KP van Eijk RV. An IgM capture enzyme linked immunosorbent assay to detect IgM antibodies to treponemes in patients with syphilis. Genitourin Med 1989;65:79–83.

Schmidt BL. Solid phase hemadsorption: A method for rapid detection of Treponema pallidum-specific IgM. Sex Transm Dis 1980;7:53–8.

Merlin S Andre J Alacoque B Paris-Hamelin A. Importance of specific IgM antibodies in 116 patients with various stages of syphilis. Genitourin Med 1985;61:82–7.

Muller F Lindenschmidt E-G. Demonstration of specific 19S (IgM) antibodies in untreated and treated syphilis: Comparative studies of the 19S (IgM)-TPHA test and the solid-phase haemadsorption assay. Br J Vener Dis 1982;58:12–17.

Panuccio A Borroni G Gelosa L. [Comparison of methods for the demonstration of Treponema-specific IgM]. Boll Ist Sieroter Milan 1989;68:145–51.

Panuccio A Gelosa L. IgM in the diagnosis of syphilis: Results on the use of the IgM solid-phase hemadsorption test. Boll Ist Sieroter Milan 1985;64:381–5.

Schmidt BL Gschnait F Luger A. Comparison of three different Treponema pallidum specific IgM-tests. Biology and pathogenicity of treponemes: conference sponsored by the WHO and the University of Birmingham 1989 (abstract).

Shannon R Copley CG Morrison GD. Immunological responses in late syphilis. Br J Vener Dis 1980;56:372–6.

Muller F Wollemann G. Analysis of specific immunoglobulin M immune response to Treponema pallidum before and after penicillin treatment of human syphilis. Eur J Sex Trans Dis 1985;2:67–72.

Pedersen NS Petersen CS Axelsen NH. Enzyme-linked immunosorbent assay for detection of immunoglobulin M antibody against the Reiter treponeme flagellum in syphilis. J Clin Microbiol 1982;16:608–14.

Tanaka S Suzuki T Shimada K Nishioka K. Low molecular weight-IgM antibody in syphilis detected by Treponema pallidum immune adherence (TPIA) test. Med Microbiol Immunol (Berl) 1984;173:155–65.

Simon RP. Neurosyphilis. Arch Neurol 1985;42:606–13.

Robertson DHH McMillan A Young H. Treatment of syphilis: General considerations. In: Clinical practice in sexually transmissible diseases. Edinburgh: Churchill Livingstone, 1989:143–57.

Fiumara NJ. Treatment of primary and secondary syphilis. JAMA 1980;243:2500–2.

Musher DM Hamill RJ Baughn RE. Effect of human immunodeficiency virus (HIV) infection on the course of syphilis and on the response to treatment. Ann Intern Med 1990;113:872–81.

Mohr JA Griffiths W Jackson R Saadah H Bird P Riddle J. Neurosyphilis and penicillin levels in cerebrospinal fluid. JAMA 1976;236:2208–9.

Dunlop EM Saftwat S Houang E. Penicillin levels in blood and CSF achieved by treatment of syphilis. JAMA 1979;241:2538–40.

Polnikorn N Witoonpanich R Vorachit M. Penicillin concentrations in CSF after treatment regimens for syphilis. Br J Vener Dis 1980;56:363–7.

Ducas J Robson HG. Cerebrospinal fluid penicillin levels during therapy for latent syphilis. JAMA 1981;246:2583–4.

Lowhagen G Brorson J. Penicillin concentrations in CSF and serum after intramuscular, intravenous and oral administration to syphilitic patients. Acta Derm Venereol 1983;63:53–7.

van der Valk PG Kraai EJ van Voorst Vader PC Haaxma-Reiche H Snijder JA. Penicillin concentrations in cerebrospinal fluid (CSF) during repository treatment regimen for syphilis. Genitourin Med 1988;64:223–5.

Musher DM. Syphilis, neurosyphilis, penicillin, and AIDS. J Infect Dis 1991;163:1201–6.

Clark R Carlisle JT. Neurosyphilis and HIV infection (letter). South Med J 1988;81:1204–5.

Jordan KG. Modern neurosyphilis—a critical analysis. West J Med 1988;149:47–57.

Bayne LL Schmidley JW Goodin DS. Acute syphilitic meningitis. Its occurrence after clinical and serologic cure of secondary syphilis with penicillin G. Arch Neurol 1986;43:137–8.

Fernandez-Guerrero ML Miranda C Cenjor C Sanabria F. The treatment of neurosyphilis in patients with HIV infection. JAMA 1988;259:1495–6.

Dunlop EM al-Egaily SS Houang ET. Penicillin concentrations in CSF during repository treatment for syphilis (letter). Genitourin Med 1990;66:227–8.

Catterall RD. Neurosyphilis. Br J Hosp Med 1977;17:585–604.

Leading Article. Routine tests for syphilis on cerebrospinal fluid. Lancet 1977;ii:595.

De Silva Y Walzman M Shahmanesh M. The value of serum TPHA titres in selecting patients for lumbar puncture. Genitourin Med 1991;67:37–40.

Luger A Marhold I Schmidt BL. Laboratory support in the diagnosis of neurosyphilis. World Health Organization 1988;WHO/VDT/RES/88.379.

Smikle MF James OB Prabhakar P. Diagnosis of neurosyphilis: A critical assessment of current methods. South Med J 1988;81:452–4.

Davis LE Schmitt JW. Clinical significance of cerebrospinal fluid tests for neurosyphilis. Ann Neurol 1989;25:50–5.

van Eijk RV Wolters EC Tutuarima JA Effect of early and late syphilis on central nervous system: Cerebrospinal fluid changes and neurological deficit. Genitourin Med 1987;63:77–82.

Hollander H. Cerebrospinal fluid normalities and abnormalities in individuals infected with human immunodeficiency virus. J Infect Dis 1988;158:855–8.

Breustedt W Bitta R Sonnichsen N. Positive fluorescent treponemal antibody absorption test in cerebrospinal fluid of nonsyphilitic persons infected with human immunodeficiency virus letter. Arch Dermatol 1989;125:1712–13.

Johnson MH Thompson EJ. Diagnosis of neurosyphilis. Hosp Update 1986;12:561–3.

Hische EA Turuarima JA Wolters EC Cerebrospinal fluid IgG and IgM indexes as indicators of active neurosyphilis. Clin Chem 1988;34:665–7.

Luger A Schmidt B Spendlingwimmer I Horn F. Recent observations on the serology of syphilis. Br J Vener Dis 1980;56:12–16.

Guidelines for the prevention and control of congenital syphilis. MMWR 1988;37 (suppl 1):1–13.

Baughn RE. Congenital syphilis: Immunologic challenges. Pathol Immunopathol Res 1989;8:161–78.

Meheus A Schryver AD. Sexually transmitted diseases in the Third World. In: Harris JRW Forster SM , eds. Recent advances in sexually transmitted diseases and AIDS. Edinburgh: Churchill Livingstone, 1991;201–17.

Meyer MP Malan AF. Rheumatoid factor in congenital syphilis. Genitourin Med 1989;65:304–7.

Sanchez PJ McCracken GH Jr. Wendel GD Olsen K Threlkeld N Norgard MV. Molecular analysis of the fetal IgM response to Treponema pallidum antigens: implications for improved serodiagnosis of congenital syphilis. J Infect Dis 1989;159:508–17.

Johnston NA. Neonatal congenital syphilis. Diagnosis by the absorbed fluorescent treponemal antibody (IgM) test. Br J Vener Dis 1972;48:465–9.

Eisenstein BI. The polymerase chain reaction—a new method of using molecular genetics for medical diagnosis. N Engl J Med 1990;323:178–83.

Saiki RK Gelfand DH Stoffel S Primer-directed enzymatic amplification of DNA with a thermostable DNA polymerase. Science 1988;239:487–91.

Hay PE Clarke JR Strugnell RA Taylor-Robinson D Goldmeier D. Use of the polymerase chain reaction to detect DNA sequences specific to pathogenic treponemes in cerebrospinal fluid. FEMS Microbiol Lett 1990;56:233–8.

Noordhoek GT Wieles B van der Sluis JJ van Embden JD. Polymerase chain reaction and synthetic DNA probes: A means of distinguishing the causative agents of syphilis and yaws? Infect Immun 1990;58:2011–13.

Hsu PL Chamberlain NR Orth K Moomaw CR Zhang LQ Slaughter CA Radolf JD Sell S Norgard MV. Sequence analysis of the 47-kilodalton major integral membrane immunogen of Treponema pallidum . Infect Immun 1989;57:196–203.

Grimprel E Sanchez PJ Wendel GD Use of polymerase chain reaction and rabbit infectivity testing to detect Treponema pallidum in amniotic fluid, fetal and neonatal sera, and cerebrospinal fluid. J Clin Microbiol 1991;29:1711–18.

Wendel GD Maberry MC Christmas JT Goldberg MS Norgard MV. Examination of amniotic fluid in diagnosing congenital syphilis with fetal death. Obstet Gynecol 1989;74:967–70.

Wicher K Noordhoek GT Abbruscato F Wicher V. Detection of Treponema pallidum in early syphilis by DNA amplification. J Clin Microbiol 1992;30:497–500.

World Health Organization Consultative Group. Development of a treponemal vaccine: current status and recommendations for further research. World Health Organization, 1990;WHO/VDT/RES/90.381.

Peterson KM Baseman JB Alderete JF. Isolation of a Treponema pallidum gene encoding immunodominant outer envelope protein P6, which reacts with sera from patients at different stages of syphilis. J Exp Med 1986;164:1160–70.

Peterson KM Baseman JB Alderete JF. Cloning structural genes for Treponema pallidum immunogens and characterisation of recombinant treponemal surface protein, P2 (P2 star). Genitourin Med 1987;63:289–96.

Hindersson P Cockayne A Schouls LM van Emden JD. Immunochemical characterization and purification of Treponema pallidum antigen TpD expressed by Escherichia coli K12. Sex Transm Dis 1986;13:237–44.

Rodgers GC Laird WJ Coates SR Mack DH Huston M Sninsky JJ. Serological characterization and gene localization of an Escherichia coli-expressed 37-kilodalton Treponema pallidum antigen. Infect Immun 1986;53:16–25.

Radolf JD Lernhardt EB Fehniger TE Lovett MA. Serodiagnosis of syphilis by enzyme-linked immunosorbent assay with purified recombinant Treponema pallidum antigen 4D. J Infect Dis 1986;153:1023–7.

Coates SR Sheridan PJ Hansen DS Laird WJ Erlich HA. Serospecificity of a cloned protease-resistant Treponema pallidum-specific antigen expressed in Escherichia coli . J Clin Microbiol 1986;23:460–4.

Ross J Moyes A Young H McMillan A. An analysis of false positive reactions occurring with the Captia Syph G EIA. Genitourin Med 1991;67:408–10.

Lefevre JC Bertrand MA Bauriaud R Lareng MB. False positive reactions occurring with the Captia Syphilis G EIA, in sera from patients with Lyme disease. Genitourin Med 1992;68:142.

Romanowski B Forsey E Prasad E Lukehart S Tam M Hook EW. Detection of Treponema pallidum by a fluorescent monoclonal antibody test. Sex Transm Dis 1987;14:156–9.