Abstract
Purpose
To determine the sensitivity and specificity of syphilis antibody tests in vitreous samples and to propose an algorithm using vitreous syphilis antibody as a supplementary test to confirm syphilitic uveitis (SU).
Methods
A prospective case-control study was conducted at the Retina and Uveitis Clinic from May 2017 to January 2020. Initially, patients were classified based on syphilis serology into group 1 (positive testing) and group 2 (negative testing). Group 1 was further divided into 2 subgroups (group 1A and 1B) depending on their relevant clinical manifestations and clinical improvement. Group 2 served as a control group.
Results
Thirty-eight patients were enrolled in the study: 14 in group 1A, 5 in group 1B, and 19 in group 2B. No patient was assigned to group 2A. All patients in group 1A, representing definite SU, completed syphilis test (rapid plasma reagin [RPR], enzyme immunoassay [EIA], and fluorescent treponemal antibody-absorption [FTA-ABS]) for vitreous, and all vitreous samples yielded positive results. Of the 5 subjects in group 1B, 3 cases were considered to be not SU with different conditions, and 2 were indeterminate for SU. They presented with different features not typical of SU, and they had variable and fewer positive syphilis antibody responses. The most sensitive test for detecting syphilis antibodies in vitreous was EIA (90.9%), followed by RPR (80.0%) and FTA-ABS IgG (78.9%). EIA and FTA-ABS had the highest specificity, detecting 100% of the syphilis antibody.
Conclusions
Vitreous analysis of syphilis antibody can serve as a supplementary test to confirm SU in selected cases as the proposed algorithm.
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Acknowledgements
The authors would like to thank Dr. Mongkol Tadarati and Dr. Jirawut Limwattanayingyong for referring the study participants, Dr. Jaruda Kobkitjaroen for the analysis of syphilitic testing, Mrs. Chananuch Plang-ngern, together with her colleagues, for their laboratory data support, and Mr. John Flanagan for English editing.
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SS conceived the study, participated in design and coordination, performed data interpretation, and drafted and edited the article. TH participated in coordination and data collection. CSF edited the article. All authors read and approved the final version of the article.
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Silpa-archa, S., Hoopholerb, T. & Foster, C.S. Appraisal of vitreous syphilis antibody as a novel biomarker for the diagnosis of syphilitic uveitis: a prospective case-control study. Eye 37, 146–154 (2023). https://doi.org/10.1038/s41433-021-01902-6
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DOI: https://doi.org/10.1038/s41433-021-01902-6
