Venereal+Disease+Research+Laboratory+test

 ** Venereal Disease Research Laboratory Test **   ** Overview **  The Venereal Disease Research Laboratory test, (better known by the acronym VDRL) is a blood test used to screen patients for syphilis. The test was initially developed by the Venereal Disease Research Laboratory (now the Treponemal Pathogenesis and Immunology Branch of the United States Public Health Service) located in Staten Island, New York. The test was initially devolved by August Paul von Wasserman with the aid of Albert Neisser in 1906. The tandem used syphilitic tissue as a complement-fixing antigen to detect the presence of anti-bodies. Extracts of other normal tissue, such as a beef heart, had similar properties and purification and standardization of these materials led to the use of a preparation containing cardiolipin and lecithin in cholesterol as antigen (Feigin, 1733). That combination was the precursor to the VDRL test that, in 1946, Harris, Rosenberg, and Riedel redeveloped for a new, more efficient test that is largely still used today. 
 * Zachary Pedersen **

   ** Testing **  ||   <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 200%;">The Venereal Disease Research Lab test is considered a nontreponemal test, or a nonspecific test that detects the syphilis infection by indirect markers. These tests detect biomarkers that are released during cellular damage from the syphilis spirochete. Spirochete is a Gram-negative bacterium, more specifically Treponema pallidum that can be distinguished from other bacterial phyla by examining the location of the flagella; a tail like projection that protrudes from the cell body of certain prokaryotic and eukaryotic cells functioning like a locomotion. T pallidum is a spirochete with closely wound coils approximately 8 to 15 um long (Fischbach & Dunning, 569). <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 200%;"> <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 200%;">The syphilitic infection leads to the production of nonspecific antibodies that react to cardiolipin (a component of the inner mitochondrial membrane, constituting approximately 20% of fat composition). This reaction allows for the VDRL and, similarly, Rapid Plasma Reagin test, to be effective tools for determining syphilis. Patients infected with T. pallidum produce a nonspecific antibody-like substance called reagin. When the VDRL antigen mixture composed of cardiolipin, cholesterol, and lecithin, is reacted with serum containing reagin, a visible reaction occurs. The test is "reactive" in 70-90% of primary and secondary syphilis cases, but is usually nonreactive in tertiary cases (Estridge, Reynolds, Walters, 536). <span style="height: 154.45pt; margin-left: 72.75pt; margin-top: 131.5pt; position: absolute; width: 323.25pt; z-index: -1;"> <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 200%;">Both the VDRL and RPR tests are flocculation tests, meaning they examine colloids in suspension and look for the formation of flakes. Definite flocculation is reported as a strongly reactive test; slight flocculation is reported as a weakly reactive test. If syphilitic lesions exist, a reactive VDRL test is diagnostic. If no lesions are evident, a reactive VDRL test necessitates repeated testing (Williams & Wilkings 176). ** <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 200%;">Disadvantages ** <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 200%;">The downside to this form of testing is that in the very early stages of primary syphilis and at the late stages of syphilis, there is a decreased sensitivity, creating a large number of patients receiving a negative test result through this form of screening. Other issues concerning these nontreponemal tests are the occurrences of false positive reactions. The VDRL titre is the highest dilution of serum that gives a positive result. Usually, a titre less than or equal to a ratio of 1:16 indicates infection. The VDRL becomes positive about 4 weeks after infection (and one week after appearance of chancre) and hence false negatives can occur very early in infection (Mysore, Venkataram et al 172). The majority of the time, this is a result of other infections, either viral or bacterial, but can also be a result of drugs, pregnancy, rheumatic fever, rheumatoid arthritis, lupus and leprosy. Therefore, it is important to have a positive test confirmed with a treponemal test that will indicate which specific antibodies are present and interacting with the present bacteria or viral infection. <span style="height: 128.25pt; margin-left: 272.25pt; margin-top: 37pt; position: absolute; width: 165pt; z-index: -6;"> ** <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 200%;">Syphilis  ** <span style="height: 21.15pt; margin-left: 272.25pt; margin-top: 118.8pt; mso-height-relative: margin; mso-width-percent: 400; mso-width-relative: margin; position: absolute; width: 230.35pt; z-index: 4;"> <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 200%;">The VDRL is a blood test used to test patients for syphilis. Syphilis is a sexually transmitted disease caused by the spirochetal bacteria Treponema pallidum. The primary source of transmission of syphilis is through sexual contact, but can also be passed from mother to fetus during pregnancy or at birth, resulting in congenital syphilis. <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 200%;"> <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 200%;"> ** <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 200%;">Stages of Syphilis ** <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 200%;">There are four different stages of syphilis; primary, secondary, latent, and tertiary. The primary stage is marked by a skin lesion appearing at the point of contact. This is called a chancre, and normally will appear between 3-90 days after the initial exposure. The secondary stage, occurring 4 to 10 weeks after the primary infection, has symptoms of reddish-pink, non-itchy rash on the trunk and extremities of the patient, including the palms and soles. The lesions that surface are harboring bacteria. Acute symptoms of secondary stage syphilis typically subside after 3 to 6 weeks of their appearance. The third stage of syphilis is considered the latent stage. Here, the patient will observe no signs or symptoms of having the disease. The fourth and final stage is the tertiary stage, occurring 3 to 15 years after the initial infection. Patients in the fourth, tertiary stage are not infectious. ** <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 200%;">Significance to Communication ** <span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 200%;">Syphilis and the most popular test to determine the presence of the bacterium T pallidum, VDRL, have a strong connection to the world of sexual communication. Because syphilis is considered a sexually transmitted disease, and is only spread by direct skin-to-skin contact, it is important to be open and honest with potential sexual partners. Abstinence is the best way to protect yourself from contracting the bacterium T pallidum; however, when sexual urges cannot be overcome, your next safest option is to communicate with your partner. It may seem strange asking specifically about their last screening for syphilis, but it could certainly save you a great deal of trouble. If left untreated, syphilis is deadly, as indicated by the following famous people who died of this terrible disease: <span style="font-family: 'Times New Roman','serif'; font-size: 12pt;"> **<span style="font-family: 'Times New Roman','serif'; font-size: 12pt;">References ** <span style="font-family: 'Times New Roman','serif'; font-size: 12pt;">
 * // Electron micrograph of T pallidum  //<span style="font-family: 'Times New Roman','serif'; font-size: 12pt; font-weight: normal; line-height: 115%;">
 * <span style="0in line-height: 200%; margin: 5pt 0in; mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none;"><span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 200%;">George Washington; the 1st president of the United States of America
 * <span style="0in line-height: 200%; margin: 5pt 0in; mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none;"><span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 200%;">Christopher Columbus; the man credited with discovering the route to America in 1492
 * <span style="0in line-height: 200%; margin: 5pt 0in; mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none;"><span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 200%;">Napoleon Bonaparte; �Enlighten Monarch�, lead the French Revolution of 1789
 * <span style="0in line-height: 200%; margin: 5pt 0in; mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none;"><span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 200%;">Al Capone; infamous Chicago based gangster
 * <span style="0in line-height: 200%; margin: 5pt 0in; mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none;"><span style="font-family: 'Times New Roman','serif'; font-size: 12pt; line-height: 200%;">Harry Nelson Pillsbury; 19th century chess master
 * <span style="display: block; line-height: normal; margin: 5pt 0in; mso-layout-grid-align: none; mso-pagination: none;"><span style="font-family: 'Times New Roman','serif'; font-size: 12pt;">Estridge, Barbara H., Anna P. Reynolds, and Norma J. Walters. (2000) //Basic Medical Laboratory Techniques// (536) 4th ed. Stanford, CT: Thompson Learning.
 * <span style="display: block; line-height: normal; margin: 5pt 0in; mso-layout-grid-align: none; mso-pagination: none;"><span style="font-family: 'Times New Roman','serif'; font-size: 12pt;">Feigin, Ralph D. (2004) //Textbook of Pediatric Infectious Diseases//. (1733) 5th ed. Vol. 2. Philadelphia, PA: Curtis Center.
 * <span style="display: block; line-height: normal; margin: 5pt 0in; mso-layout-grid-align: none; mso-pagination: none;"><span style="font-family: 'Times New Roman','serif'; font-size: 12pt;">Fischbach, Frances Talaska, and Marshall Barnett Dunning. (2004) //A Manual of Laboratory and Diagnostic Tests//. (569) 8th ed. Philadelphia PA: Lippincott Williams & Wilkins.
 * <span style="display: block; line-height: normal; margin: 5pt 0in; mso-layout-grid-align: none; mso-pagination: none;"><span style="font-family: 'Times New Roman','serif'; font-size: 12pt;">Mysore, Venkataram, and Venkataram Et Al. (2007) //Dermatalogical Diseases : A Practical Approach//. (172) Janpath, New Delhi: BI Publications Pvt.
 * <span style="display: block; line-height: normal; margin: 5pt 0in; mso-layout-grid-align: none; mso-pagination: none;"><span style="font-family: 'Times New Roman','serif'; font-size: 12pt;">Williams, Lippincott, and Wilkins. (2009) //Diagnostic Tests Made Incredibly Easy!// (176) 2nd ed. Philidelphia PA: Lippincott Williaams & Wilkins.