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A 35-year-old man with no significant past medical history comes to the office complaining of malaise, fever, headache, and a diffuse, nonpruritic, maculopapular rash that has spread from his palms and soles over the last ten days. A recent test for HIV was negative. On physical examination, he has a temperature of 100.5 F. There are mucocutaneous patches at the angles of the mouth, and the palate and pharynx are inflamed. He has generalized adenopathy with a maculopapular rash on the margins of the ribs, lateral trunk, and all four extremities. The rash on the palms and soles is hyperpigmented with a superficial scale. There is a large, pale, flat-topped papule found in the perineum. What would be the test of choice to follow this patient's response to treatment?
(A) Darkfield microscopy
(B) FTA-ABS
© MHA-TP
(D) VDRL
(E) Serial clinical examinations
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aaaaaaaaaaaaa................ what's that MHA-TP??????????
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aaaaaaaaaa....
microhemagluttination trepanema pallidum test
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Darkfield microscopy is good for diagnosis but not patient's response to treatment?
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secondary syphilis...finding the organism is most specific....VDRL is not a specific test with many false positives....i think...any other opinion
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I PUT LICHEN TO CONFUSE YOU GUYS MORE ...........
(D) VDRL
Explanation:
The VDRL test is the initial test for syphilis. The VDRL is readily quantified, and for that reason is the test for following the response to treatment. The VDRL test begins to turn positive within one week after the onset of the chancre and is positive in 99% of patients with secondary syphilis. The quantitative titer of the VDRL test is somewhat useful in initial diagnosis of a chancre but quite useful in following a therapeutic response. Most patients with secondary syphilis have titers of at least 1:32, whereas most patients with false-positive VDRL tests have titers of less than 1:8. Significant rises of fourfold or greater of acute and convalescent sera are strongly indicative of acute syphilis. The FTA-ABS test is best used as a confirmatory test. It is more difficult to perform than the VDRL test and cannot be as easily quantified. It is reported in terms of relative brilliance of fluorescence, from borderline to 4+. The FTA-ABS test often remains reactive for life despite adequate therapy and therefore would not be useful in following a patient's response to treatment. Agglutination of red blood cells to which T. pallidum antigens have been fixed is the basis of the microhemagglutination assay for T. pallidum (MHA-TP). It is less sensitive than either the VDRL or the FTA-ABS test in primary syphilis. Treponemal tests, such as the FTA or MHA-TP, do not correlate well with the degree of disease activity. The Wright stain of the scrapings is diagnostic for granuloma inguinale, or donovanosis. The Tzanck prep detects multinucleated giant cells or intracellular inclusion bodies of herpes simplex or varicella zoster. Darkfield microscopy is diagnostic for primary syphilis alone and is not used to follow the
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Darkfield microscopy is diagnostic for primary syphilis alone and is not used to follow the response for treatment.
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