Role of the Venereal Disease Research Laboratory test in the detection of syphilis.

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Abstract
Of 9733 consecutive serological samples received by Portsmouth and Southampton [England, UK] Public Health Laboratories and tested for syphilis, 190 (140 from men and 50 from women) gave positive results; 30 new cases of syphilis were identified. Most sera were tested initially by a specific antibody test (the Treponema pallidum hemagglutination (TPHA) test) and a cardiolipin test (the Venereal Disease Research Laboratory [VDRL] test). Among the 14 patients whose sera gave VDRL-positive but TPHA-negative results, 12 sera gave false-positive results. The sera of 90 patients gave TPHA-positive but VDRL-negative results; sera from only 7 of these patients gave false-positive results. The VDRL test is very unlikely to identify a new case of syphilis where a TPHA test has failed to do so. Thus, the VDRL test should be withdrawn from initial testing for syphilis except where early primary disease is suspected.