The incidence of syphilis in China in recent years is a rising trend, in recent years, China’s Center for Disease Control epidemic report shows that the incidence of syphilis is increasing year by year, in the sexually transmitted diseases, has been ranked first, in the epidemic of statutory infectious diseases has reached the third, syphilis should cause us to pay sufficient attention to the common laboratory tests, such as RPR, is rapid plasma reaction test, and TRUST, these two tests are non-syphilis spirochete antigen serum test. These two experiments are non-syphilis spirochete antigen serum experiments, the principle of the experiment is this, is to use the normal components of human tissue, cardiolipin as an antigen, the determination of serum cardiolipin antibodies, in the process of syphilis spirochete destruction of human tissue, will release a large number of cardiolipin, in the body will produce non-specific antibodies, that is, cardiolipin antibodies, TRUST experiment and The TRUST test and the RPR test are based on the principle of using cardiolipin as an antigen to monitor cardiolipin antibodies in the serum, and if there is a positive reaction, we define it as a positive RPR test or a positive TRUST test. The qualitative test is the question of positive and negative, if it is simply positive for RPR or TRUST, it is a qualitative test, and negative is not reactive. But in our clinical follow-up and observation, we generally see relatively more quantitative experiments, because quantitative experiments can reflect the approach to the disease and play a very important role in follow-up, such as in the clinic will often encounter that the RPR or TRUST serum test is 1:1, 1:2, 1:4, etc., is the result of a multiplicative dilution. Do RPR, TRUST experiments, the beginning of the original concentration of the patient’s serum with the reagents we say to experiment, if the experiment is positive, we can do a comparison of the patient’s serum dilution to see if the dilution of two times the negative results, and so on, diluted 4 times, 8 times, to see at what multiple is positive, if the dilution to 64 times is a negative result, we issued a report The result is 1:32. The clinical significance of RPR and TRUST, we can perform screening tests in some cases of census, premarital and prenatal health checkups. Of course, the RPR and TRUST may encounter some false positives in the clinic, and there may be biological false positives, such as acute febrile infectious diseases, pregnancy, drug addiction, lupus erythematosus, rheumatoid arthritis, the RPR may also appear a positive situation, but the general titer will be less than 1:8, if we encounter a patient in the clinic with some similar conditions, we should also consider the RPR and TRUST. If we encounter a patient in the clinic with some conditions like this, we should also consider the question of whether there is an impact on the titer. What is the sensitivity of RPR and TRUST tests? We have done some statistics, RPR and TRUST on the sensitivity of untreated syphilis, generally speaking, the positive rate of Phase I syphilis can reach more than 80%, like Phase II syphilis RPR positive rate of 100%, the general Phase II syphilis body antibodies are relatively more, monitoring the positive rate can reach 100%, late syphilis, latent syphilis in more than 98%. Non-syphilis spirochetes are generally low. Generally speaking, 97% of seropositive stage 1 syphilis and 76% of stage 2 syphilis patients will turn seronegative within two years after treatment, and both stage 1 syphilis and stage 2 syphilis belong to early syphilis. Many hospitals say that the titer of syphilis is relatively high, and after treatment there is a decline, the doctor said that the treatment is very effective, you can continue to observe, but this situation is effective does not mean that the cure, if the treatment has more than 4 times the decline is proved to be effective, but also to follow up two to three years, if the time is not enough, or further follow-up, because in this process there will be a part of the serum The problem of recurrence and fixation. In the clinic, we also encounter a more interesting phenomenon, we say in the clinical potential phenomenon, generally in the second stage of syphilis is more common, this is a weak positive or false negative situation, that is, because the concentration of antibodies in the blood is relatively high, the original kind of serum to do RPR or TRUST, may appear negative results, this situation because the relatively high antibody, do Once the patient’s serum is diluted, there will be a positive reaction with a higher titer. Therefore, in our clinical observation, if some patients have clinical manifestations like stage II syphilis, but the serum is negative, we must do a serum dilution during the experiment to clarify if there is a potential phenomenon. The sensitivity of RPR and TRUST is relatively high, the specificity is low, and the titer of the subject is relatively correlated with the activity of the disease, with a 4-fold difference between before and after, which means that it is significant. The general RPR and TRUST test, after adequate treatment, phase I syphilis, phase II syphilis will gradually turn negative. The clinical serological test for syphilis is the syphilis spirochete antigen serological test, which is a confirmatory test for syphilis, a positive test for syphilis, commonly used is TPPA. Another test is the IGMFTABS, which in Chinese is the simple immunofluorescence method, and this method is relatively less used in the clinic. Syphilis spirochete antigen serum test, it is the use of live or dead syphilis spirochetes, or its components as antigens to monitor syphilis spirochete antibodies, if the body has such anti-syphilis spirochete antibodies, this test will appear a positive result, using this test to confirm whether the infection is syphilis, this is the confirmatory test of syphilis. The characteristics of this test, generally high sensitivity, specificity, this test is generally used to do syphilis diagnostic confirmation test, another feature of it, antibodies long-term or even lifelong existence, of course, a relatively small number of people can turn negative after two years, but the vast majority of patients after treatment, long-term or lifelong positive situation, so in the clinical changes, it is generally not used for the observation of the efficacy of treatment. The antibody titer and disease activity is not correlated, in the clinic, many patients take the TPPA titer, said the titer is 1:80, or 1:256, said the titer how so high ah, generally speaking, this and RPR and TRUST titer is not correlated, prove that his body anti-syphilis spirochete antibody concentration, generally does not have much to do with syphilis, if there is such a If there is such a titer, we do not have to care too much about the titer, as long as there is a positive result, it is clear that the diagnosis of syphilis, we then observe the RPR titer to see the situation of the disease. In the case of false positive syphilis serum reaction, generally like in the hard chancre stage of stage I syphilis patients, the serum reaction may appear negative, and such clinical manifestations appear, antibodies have not yet formed and cannot be detected. In general, syphilis antibodies can be detected 10 days after the appearance of the hard chancre in stage 1 syphilis, but if the hard chancre has just appeared, some patients cannot be detected. The first time the patient is treated for more than two years, the serum does not turn negative, which is called serum fixation. The first one is the dark-field microscopy, where we take the hard chancre of stage I syphilis or the skin lesion of stage II syphilis, and take some tissue fluid to observe the presence of syphilis spirochetes under the dark-field microscope. The other is histological examination, which is done on the hard chancre and rash to see if there are any specific manifestations of syphilis. In stage I syphilis, the presence of syphilis spirochetes can be detected in the dark field, such as lymph nodes and hard chancre, and the presence of RPR, TRUST and TPPA can be detected in the blood of stage I syphilis. In the third stage of syphilis, late syphilis, we should consider the blood and cerebrospinal fluid examination, the blood should also check the antibody test, the cerebrospinal fluid to do brain cytology and biochemical examination, in addition to the cerebrospinal fluid syphilis spirochete monitoring, to determine the presence of neurosyphilis. The dark-field microscopic examination has a positive rate of no more than 50%, and the sensitivity of this test is not too high. TPPA is a confirmatory test for syphilis, and the sensitivity of TPPA reaches 100% for second-stage syphilis and 97% for latent density and late syphilis. The specificity of TPPA is 99%, and there is also a 1% false positive, but generally speaking, the specificity is still relatively high. Another test is the FTAABS test, which is more sensitive than TPPA. In clinical practice, we can also test for syphilis spirochete IGM antibody serology, which produces IGM antibodies in the early stages of syphilis. If IGM antibodies are detected in the blood of the newborn, it can confirm the problem of congenital infection, and if detected in the cerebrospinal fluid, it proves that it is active cerebral neurosyphilis. What does it mean when we get a laboratory test that is positive for RPR and negative for TPPA? In this case, we say it is a problem of false positive RPR, because the RPR is positive, but the confirmatory test TPPA is negative, this is a false positive report, this situation can not diagnose syphilis. The other case is a positive RPR and a positive TPPA, which is diagnostic of syphilis. In the case of a pregnant woman whose mother is a syphilis patient and whose newborn is in this condition, is she infected with syphilis? If the titer of the newborn is higher than the mother’s, it is considered to be a case of congenital syphilis. If it is the same as or lower than the mother’s, it may not be syphilis. This is the case of RPR positive and TPPA negative, which generally represents very early syphilis, such as stage 1 syphilis, and also previous syphilis infection, which has not been cured after treatment. The problem is that the antibodies are not produced in the later stages of the bed. The first thing you need to do is to make sure that you have a good understanding of your own condition, and to make sure that you are followed up in a timely manner. Follow-up visits to see if there is no infection and if the titer has turned negative.