25 year old labourer 3 years back presented with penile ulcer not treated. Later he presented with neurological symptoms for which he got treated. Test to monitor response to treatment is ?
Correct Answer: VDRL
Description: Ans. is 'a' i.e., VDRL . Neurological symptoms in a patient with history of untreated ulcer 3 years back suggests the diagnosis of neurosyphilis. To fuher clear the doubts, all the given options are serological tests for syphilis. So, the examiner is asking about the syphilis for sure. . It has alreadys been explained that for monitoring of response of therapy non specific serological tests (VDRL or RPR) are used as the specific treponemal tests remain positive inspite of treatment. Now question arises, whether to use VDRL or RPR as both the options are there in this question. Following statement will clear your doubts? " The VDRL ( a standard test) will often indicate cure as measured by negative serologies by 12 months after therapy, whereas the RPR shows only 50% seroconversion i.e. negative serology at one year"....................... Annals on internal medicine Like VDRL test RPR test can also be used to monitor the treatment in syphilis but it is not suitable for testing C.S.F., so it cannot be used in neurosyphilis. . Titres are not interchangable between different test types. Hence, the same non-treponemal test should be used for follow up. e.g. if one has used VDRL at first follow up, then VDR1 should be used at every follow up. You should also keep in mind that though after adequate treatment of syphilis non treponemal tests (non specific tests) eventually become non-reactive. Sometimes even with sufficient treatment patients have a persistent low level positive nontreponemal test, reffered to as a serofast reaction.
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