False positive venereal disease research laboratory of cerebrospinal fluid

Abstract Background The Venereal Disease Research Laboratory (VDRL) test performed in cerebrospinal fluid (CSF) is considered highly specific for the diagnosis of neurosyphilis, but algorithms to diagnose neurosyphilis require positive syphilis serologic testing prior to obtaining CSF-VDRL. Inappropriate use of diagnostic tests depletes healthcare resources, and contributes to rising healthcare expenditures. CSF-VDRL has historically been improperly utilized; however there is no recent evaluation of its use in clinical practice. We aimed to quantify rates of appropriate CSF-VDRL testing, determine the CSF-VDRL false-positivity rate and describe causes of false-positive CSF-VDRL reactivity. Methods In this retrospective cohort study of three Mayo Clinic sites (Rochester, MN, Jacksonville, FL, and Scottsdale, AZ), we measured the rate of appropriate CSF-VDRL test utilization in patients with negative testing from January 1, 2011 to December 31, 2017. We then identified all patients with positive CSF-VDRL testing from January 1, 1994 to February 28, 2018, characterized true- and false-positive rates and described causes of CSF-VDRL false-positivity. Results Among 8,553 persons with negative CSF-VDRL results, testing was unnecessarily ordered in 8,399 (98.2%). The word “syphilis” or “neurosyphilis” appeared in the notes of only 1,184 (13.8%) individuals with a negative CSF-VDRL result. From January 1994 through February 2018, 33,933 CSF-VDRL tests were performed on 32,626 individual patients. Among 60 positive CSF-VDRL results, 41 (68.3%) were true-positives, 2 (3.3%) were indeterminate, and 17 (28.3%) were false-positives. Every patient with true-positive CSF-VDRL had positive serologic syphilis testing prior to CSF testing. All patients with false-positive CSF-VDRL results were inappropriately tested. Neoplastic meningitis was a common cause of false-positive CSF-VDRL results. Conclusion This is the first study in decades to review CSF-VDRL utilization for the diagnosis of neurosyphilis. Inappropriate use of CSF-VDRL testing for diagnosis of neurosyphilis remains problematic in clinical practice. Following recommended testing algorithms would prevent unnecessary testing, preserve resources, and minimize false-positive results. Disclosures All Authors: No reported disclosures

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False-Positive Venereal Disease Research Laboratory Tests in the Cerebrospinal Fluid With Meningeal Carcinomatosis

Infectious Diseases in Clinical Practice ◽

10.1097/ipc.0000000000000228 ◽

2015 ◽

Vol 23 (3) ◽

pp. e13-e14 ◽

Cited By ~ 2

Author(s):

Arthur Gran ◽

Burke A. Cunha

Keyword(s):

Cerebrospinal Fluid ◽

False Positive ◽

Research Laboratory ◽

Laboratory Tests ◽

Venereal Disease ◽

Meningeal Carcinomatosis ◽

Venereal Disease Research Laboratory ◽

Disease Research

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Biological false-positive tests comprise a high proportion of Venereal Disease Research Laboratory reactions in an analysis of 300,000 sera

International Journal of STD & AIDS ◽

10.1258/095646205774763207 ◽

2005 ◽

Vol 16 (11) ◽

pp. 722-726 ◽

Cited By ~ 43

Author(s):

Alexandra Geusau ◽

Harald Kittler ◽

Ulrike Hein ◽

Edda Dangl-Erlach ◽

Georg Stingl ◽

...

Keyword(s):

Retrospective Study ◽

False Positive ◽

Research Laboratory ◽

Venereal Disease ◽

Treponema Pallidum ◽

Venereal Disease Research Laboratory ◽

Transmitted Infection ◽

Specific Test ◽

Disease Research ◽

Syphilis Screening

This retrospective study on syphilis screening at the sexually transmitted infection (STI) unit of a University Department emphasizes the necessity of a treponemal-specific test as the appropriate screening test. The Venereal Disease Research Laboratory (VDRL) test for syphilis screening may, under certain circumstances, yield positive results in patients not infected with Treponema pallidum, a phenomenon referred to as biological false-positive (BFP) VDRL test. The aim of this study was to determine the frequency of BFP tests in a large sample of sera. In this retrospective study, we analysed the results of parallel VDRL and T. pallidum haemagglutination (TPHA) testing of a total of 514,940 blood samples obtained from patients at the Vienna General Hospital between January 1988 and November 1999. Patients' sera with incomplete data on stage and sex and duplicate sera were excluded, leaving 300,000 sera for analysis. The seroprevalence for syphilis was 1.77% ( n = 5320), as determined by a positive TPHA test. It was significantly higher in male than in female patients (2.03% versus 1.58%, P<0.001). Of the patients reactive in the TPHA test, 3257 (61.2%) were negative in the VDRL. With regard to reactivity in VDRL testing, 2799 patients (0.92%) of the study population were positive, of whom 736 (26%) were biological false positive. BFP reactivity was found in 0.24% of all patients and was significantly higher in women than in men (0.27% versus 0.20%, P<0.001) and in patients over 60 years of age (0.34%) as compared with those under 60 (0.25%, P<0.001). This proportion might be even higher, as reactivity in the VDRL at 1:0 and 1:2 dilutions without a positive treponemal test was not reported. The subgroup of HIV-positive patients ( n = 1415) revealed a 10-fold higher rate of BFP tests (2.1% versus 0.24), an effect being statistically significant. In a low syphilis prevalence population, BFP reactions comprise a high proportion of all VDRL reactors. Therefore, the use of the VDRL as a screening procedure is challenged.

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