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VDRL reflex Syphilis Total ABS

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Syphilis screening.

₹740₹1,057

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VDRL Reflex Syphilis Total ABS - Comprehensive Medical Test Guide

  • Why is it done?
    • Test Purpose: This test is a two-step screening and confirmation method for syphilis detection. The VDRL (Venereal Disease Research Laboratory) is the initial screening test for nontreponemal antibodies, and if positive, it automatically reflex (proceeds) to the Syphilis Total ABS (treponemal antibody) confirmatory test to rule out false positives.
    • Primary Indications: Routine prenatal screening in pregnant women; blood bank or organ donation screening; sexually transmitted infection (STI) screening in symptomatic patients; evaluation of suspected syphilis in patients with genital ulcers, rash, or systemic symptoms; contact tracing for sexual partners of confirmed syphilis cases; evaluation of patients with neurological or cardiovascular symptoms suggestive of tertiary syphilis; surveillance in high-risk populations.
    • Typical Timing and Circumstances: Performed at first prenatal visit as part of standard obstetric care; ordered during routine health maintenance examinations; performed when a patient presents with signs or symptoms of syphilis (typically 3-4 weeks after infection); ordered when exposure to syphilis is suspected; performed as part of comprehensive STI panels in sexually active individuals; repeated during treatment monitoring and post-treatment follow-up.
  • Normal Range
    • VDRL Result (Screening Test): Reported as either Negative/Non-reactive or Positive/Reactive with titer (if positive). Titers range from 1:1 (lowest) to 1:256 or higher (highest). Normal/expected result is Non-reactive (negative).
    • Syphilis Total ABS (Confirmatory Test): Reported as either Non-reactive (negative) or Reactive (positive). This test does not provide titers. Normal/expected result is Non-reactive (negative).
    • Interpretation Framework: Negative/Negative: No syphilis infection detected (normal result). Positive/Positive: Indicates active or past syphilis infection (abnormal result). Positive/Negative: False positive VDRL (seen in autoimmune diseases, chronic infections, or technical error) - does not indicate syphilis.
    • Units of Measurement: VDRL is reported as titers (dilution ratios such as 1:4, 1:8, 1:16, 1:32, 1:64, 1:128, 1:256, or higher). Syphilis Total ABS is reported as qualitative result only (Reactive/Non-reactive).
  • Interpretation
    • VDRL Non-reactive + Syphilis Total ABS Non-reactive: No evidence of syphilis infection. Patient is negative for syphilis antibodies. This is the normal, expected result.
    • VDRL Reactive (positive titer) + Syphilis Total ABS Reactive: Confirms active or past syphilis infection. The VDRL titer indicates disease activity: low titers (1:4-1:8) may suggest late syphilis or adequately treated infection; high titers (1:16 or greater) suggest active primary or secondary syphilis. Requires clinical correlation and additional evaluation for stage of disease.
    • VDRL Reactive + Syphilis Total ABS Non-reactive: False positive VDRL result - does NOT indicate syphilis infection. Commonly seen in patients with systemic lupus erythematosus (SLE), rheumatoid arthritis, antiphospholipid syndrome, pregnancy, chronic hepatitis C, HIV infection, tuberculosis, or other chronic infections. No syphilis-specific treatment needed; causes of biological false positive should be investigated.
    • Clinical Significance of VDRL Titers: Low titers (1:1-1:8): May indicate latent syphilis, very early primary syphilis, adequately treated syphilis, or false positive. High titers (1:16-1:256+): Suggest active primary or secondary syphilis with significant bacterial burden. Titer trends are more clinically meaningful than single values; rising titers indicate progression or inadequate treatment; falling titers after treatment indicate appropriate response to therapy.
    • Factors Affecting Results: Timing of infection: Antibodies typically appear 3-4 weeks after primary infection; very early primary syphilis may test negative. Stage of infection: Primary syphilis (50-70% VDRL positive), secondary syphilis (almost 100% positive), tertiary syphilis (70-80% positive). Treatment status: Treponemal antibodies (Syphilis Total ABS) persist indefinitely after treatment; nontreponemal antibodies (VDRL) typically decline with appropriate treatment. Immunological status: HIV-positive patients may have delayed or absent antibody response; immunocompromised patients may have false negatives. Prozone effect: Very high antibody titers may paradoxically produce negative results requiring test dilution.
    • RPR Test Alternative: Some laboratories use RPR (Rapid Plasma Reagin) instead of VDRL as the initial screening test; results are clinically equivalent and similarly require reflex to treponemal confirmation if positive.
  • Associated Organs
    • Primary Organ System Involved: The immune system (humoral immunity - antibody production by B lymphocytes). Syphilis caused by the bacterium Treponema pallidum affects multiple organ systems depending on stage and duration of infection.
    • Diseases and Conditions Detected: Primary syphilis: Presents as painless genital ulcers (chancre) typically 3-90 days after exposure. Secondary syphilis: Systemic infection with rash, fever, lymphadenopathy, mucous patches, condyloma lata; occurs 4-10 weeks after primary infection. Early latent syphilis: Asymptomatic stage within first year of infection; positive serology without clinical manifestations. Late latent syphilis: Asymptomatic stage after first year; patients remain seropositive but non-infectious (except in pregnancy). Neurosyphilis: Central nervous system involvement; includes asymptomatic neurosyphilis, meningitis, meningovascular disease, paresis, tabes dorsalis. Tertiary syphilis: Late manifestations including cardiovascular syphilis (aortitis, aortic valve insufficiency), neurosyphilis, gummatous syphilis (granulomatous lesions). Congenital syphilis: Vertical transmission from mother to fetus; can result in stillbirth, neonatal death, or serious sequelae including hydrocephalus, deafness, cardiac abnormalities.
    • Organ Systems Affected by Syphilis: Reproductive system: Genital ulcers, increased susceptibility to HIV; congenital syphilis affects fetus. Cardiovascular system: Aortic inflammation (aortitis), aortic insufficiency, coronary artery narrowing, aneurysm formation. Nervous system: Meningitis, stroke (meningovascular disease), dementia (paresis), ataxia (tabes dorsalis), posterior column degeneration, optic neuritis. Cutaneous system: Rash in secondary syphilis, gummas (nodular lesions) in tertiary syphilis. Skeletal system: Periostitis, osteitis, bone gummas causing pathological fractures. Hepatic system: Hepatitis, cirrhosis in tertiary syphilis. Ocular system: Interstitial keratitis, uveitis, posterior uveitis, retinal involvement.
    • Complications of Untreated Syphilis: Progressive neurosyphilis with dementia and neurological deterioration; cardiovascular complications including sudden death from aortic rupture; permanent blindness from uveitis; deafness from auditory involvement; congenital syphilis in offspring resulting in severe disability or death; increased susceptibility to opportunistic infections in HIV-coinfected individuals; significantly reduced life expectancy if untreated.
  • Follow-up Tests
    • Confirmatory Testing: TP-PA (Treponema pallidum Particle Agglutination): Alternative confirmatory test; more specific than FTA-ABS. FTA-ABS (Fluorescent Treponemal Antibody - Absorbed): Highly specific treponemal test; may be used if Syphilis Total ABS results are borderline or unavailable. Treponemal pallidum IgM: Helps differentiate recent infection from past treated infection; useful in early primary syphilis when IgM appears before IgG.
    • Testing for Neurosyphilis: CSF (Cerebrospinal Fluid) VDRL: Indicated if neurosyphilis is suspected; essentially 100% specific if positive. CSF FTA-ABS: Less specific than CSF VDRL but may be positive when VDRL is negative in some cases of neurosyphilis. CSF analysis: Cell count (lymphocytic pleocytosis), protein, glucose; abnormalities support neurosyphilis diagnosis. RPR or VDRL on CSF: Alternative nontreponemal test on cerebrospinal fluid.
    • Cardiovascular Assessment: Chest X-ray: Evaluates for aortic involvement, aortitis, or thoracic aortic aneurysm. ECG (Electrocardiogram): Assesses for aortic valve insufficiency, conduction abnormalities. Echocardiography: Evaluates aortic root dilation, aortic insufficiency, other cardiac manifestations. CT or MRI imaging: Evaluates for aortic aneurysm or other vascular complications.
    • Neurological Evaluation: Lumbar puncture (Spinal Tap): Indicated if neurosyphilis is suspected; allows CSF analysis and VDRL testing. Brain MRI or CT: Evaluates for stroke, meningitis, or other CNS involvement. Ophthalmologic examination: Evaluates for uveitis, keratitis, or other ocular manifestations.
    • Additional STI and Infectious Disease Testing: HIV testing: All syphilis patients should be tested; syphilis increases HIV transmission risk and is associated with more aggressive disease in HIV-positive patients. Gonorrhea and Chlamydia testing: Screen for other common STIs using NAAT (nucleic acid amplification testing). Hepatitis B and C serology: May be indicated based on epidemiology and risk factors. RPR/VDRL in sexual partners and contacts: Contact tracing to identify and treat other infected individuals.
    • Treatment Monitoring and Follow-up Testing: Quantitative VDRL/RPR at 6 and 12 weeks after treatment: Nontreponemal antibody titers should decrease (typically 4-fold) after appropriate therapy. Annual VDRL titers for 3 years: Monitor for serological cure or evidence of relapse. Repeat CSF examination: For neurosyphilis patients at 6 and 12 months post-treatment to ensure adequate CNS sterilization. Treponemal antibody testing: Remains positive indefinitely; not used for treatment response monitoring. Serological relapse evaluation: If titers rise after initial decline, repeat Syphilis Total ABS and evaluate for treatment failure or reinfection.
    • Prenatal and Neonatal Screening: Repeat VDRL/RPR in third trimester and at delivery: Identifies new infections during pregnancy. Neonatal blood and CSF testing: Newborns of seropositive mothers require evaluation for congenital syphilis. Neonatal imaging: Long bone radiographs, chest X-ray if congenital syphilis suspected.
  • Fasting Required?
    • Fasting Status: No - Fasting is NOT required for this test.
    • Patient Preparation: The test requires only a standard blood draw (venipuncture). Patients may eat and drink normally before the test. No dietary restrictions are necessary. The test can be performed at any time of day without regard to meals.
    • Medications: No medications need to be avoided or held before this test. Patients should continue taking all prescribed medications as directed unless specifically instructed otherwise by their healthcare provider. Antibiotic therapy should NOT be started before blood collection if syphilis is suspected, as premature treatment may interfere with diagnostic accuracy. Previous or ongoing syphilis treatment does not affect the ability to perform this test.
    • Specimen Collection: Typically 1-2 mL of venous blood is collected in a serum separator tube (SST) or other appropriate tube as specified by the laboratory. No special collection containers are required beyond standard phlebotomy tubes.
    • Sample Handling and Processing: Blood is allowed to clot at room temperature, then centrifuged to obtain serum. The VDRL screening is performed first. If VDRL is negative, the specimen is reported as negative with reflex testing complete. If VDRL is positive, the reflex to Syphilis Total ABS (treponemal antibody test) is automatically performed on the same specimen.
    • Timing and Results: Results are typically available within 1-3 business days, though some laboratories may provide results the same day depending on workflow and testing methodology.

How our test process works!

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