Positive test for syphilis during pregnancy. How to take a blood test for the Wasserman reaction - research indications, preparation and interpretation of the results

06.10.2012

Wasserman reaction (RW) is a method for diagnosing syphilis. A blood test for RW is mandatory for those who undergo a professional medical commission, during pregnancy - repeatedly, when donating blood by donors.

This research method, aimed at diagnosing syphilis, began to be used in 1906.

A blood test for syphilis for pregnant women is mandatory, it is prescribed to everyone without exception. Its purpose is to diagnose the presence or absence of syphilis in the body of a pregnant woman, to determine its stage. An infectious disease doctor or a gynecologist, according to the results of the analysis, if necessary, prescribes treatment. Then he monitors its course, the changes in the body that occur during treatment.

The Wasserman reaction (RW) during pregnancy is carried out three times, namely:

• at the moment when a woman becomes registered in the antenatal clinic;
• at 30 weeks pregnant;
• immediately before childbirth or before admission to the hospital.

No special preparation is required for diagnosis. Blood is taken from the cubital vein. Preferably in the morning, before taking the test, do not eat anything. For a day, exclude fatty and fried foods from the diet, do not drink alcohol.

The result of the analysis, of course, can be negative - which means that there is no syphilis virus in the body and the woman is completely healthy. If the result is positive, it has several classifications, that is, a different number of pluses:

• one (+) means the reaction is questionable;
• two (++) - in this case, the reaction is weakly positive;
• three (+++) - the reaction is positive;
• four (++++) - sharply positive reaction.

Wasserman reaction (RW) during pregnancy sometimes gives a false positive reaction. By itself, pregnancy can provoke it. This happens in 1.5% of cases. In order to confirm or refute such a diagnosis, a pregnant woman in the clinic will be assigned a number of additional studies to identify antibodies to the disease in the body. But not always, by these additional tests, it is possible to confirm that the reaction to syphilis is false positive. In this case, the doctor prescribes to the woman a special therapy that is aimed at treating syphilis in order to prevent a congenital infection in her baby.

You should not refuse such treatment, because congenital syphilis is very difficult to treat, but it is very difficult for babies. Therefore, it is recommended that a pregnant woman be tested several times for the Wessermann reaction.

In 2011, at the 12th week of pregnancy, I took tests at the LCD in Kiev. And here it turns out that RV gives +. Without explaining anything, they sent me to the tanning dispensary at the place of registration (Kirovograd). At the same time, having already read everything on the Internet, I am going with the firm intention that I will not give consent to a course of antibiotic treatment. My husband is the only man, and he is 100% healthy (every year passes the commission). I got to an adequate doctor, who decided to immediately examine me, and not send me to the hospital. I handed over also a smear -, microreaction -, РВ+, RIF -. Thus completely was surveyed also the husband - all is negative. She gave me a certificate that it was some kind of seropositive reaction during pregnancy. And so every month before giving birth I went to her for tests. All the results were repeated for me, as in the first time (once, however, RV gave ++). I won’t tell you what I experienced during that pregnancy, when in Kyiv they didn’t want to register me, and at the place of registration they looked at me like I was a leper. But in the maternity hospital, after looking at the certificates, no one asked anything, and I gave birth, like everyone else ...
After giving birth, I didn’t have the opportunity to retake tests in my tannery (I immediately left for Kyiv). We agreed with the doctor that at the first opportunity I would call in and hand over everything again. But 2 years have passed. I was sure that everything would be normal and the tests would become negative. But it so happened (I took tests in Kursk) that again RV gives ++. I was in tears again on the Internet, I found such information that even during lactation this analysis can also give a false positive result. I finished breastfeeding (1 year 10 months) literally a week before the test. And a week ago I went to Kirovograd. Passed RV ++++, RIF and RPGA + (but said that it is accepted as negative). I do not know what to do!!! The doctor prescribed repeated tests, if there are such results again, you will need to go to Kharkov (they do some kind of analysis that will definitely put everything in its place).
1. What could be the reason why my RV results jump so much?
2. How can these tests behave in future pregnancies?
3. Could I somehow get sick with syphilis (I don’t even know how I could get infected) without noticing anything (I wasn’t treated with antibiotics at all!)? At the same time, everything is negative with her husband.
4. If it really is syphilis, what should I do with my daughter - does she also need to be examined? Most of all I fear for her health!

The Wasserman reaction is the basis for diagnosing a disease such as syphilis. The classic version of this study has not been used in the Russian Federation since the 1980s, however, the underlying foundation is used in analogues.

Syphilis is an infectious disease caused by Treponema pallidum (treponema pallidum). Infection with syphilis occurs mainly through sexual contact, and vertical transmission of the infection is also possible (during childbirth from an infected mother to a child).

The course of the disease is characterized by constant progression, the presence of relapses, the frequency of clinical symptoms and the ability to affect all organs and systems of the body.

To diagnose syphilis, special tests are used:

• non-treponemal (precipitation microreaction (RPR - anticardiolipin test), Wasserman reaction, VDRL microscopic test, AgCL syphilis and others),
• treponemal (ELISA, RIF, RPHA, treponem immobilization reaction, immunoblotting, etc.).

The most "classic" test is the Wasserman reaction.

For reference. The Wasserman reaction is an immunological method for diagnosing syphilis based on the complement fixation reaction.

The essence of RW is that the blood of a patient with syphilis, when a special aggressor protein is added to it, is able to form complement-absorbing complexes with it, which will precipitate.

How is a Wasserman blood test performed?

That is, an artificial analogue of treponema (cardiolipin antigen) and a special binding protein (compliment) are attached to the patient's blood serum. If antibodies (specific defender proteins) to pale treponema are present in the blood, then the cardiolipin antigen and these antibodies bind with the participation of complement. The resulting compound precipitates, rated as ++++.

Normally, in the serum of healthy people, hemolysis of erythrocytes occurs. That is, there are no antibodies in the blood with which the cardiolipin antigen can react, and, therefore, there is no reaction of adsorption and complement fixation in the serum. Free complement is involved in hemolysis, the appearance of which is assessed as a negative Wasserman reaction, that is, “-“.

A blood test for the Wasserman reaction has five answer options:

• - (indicates that complete hemolysis of red blood cells occurred in the serum, which means that the analysis for syphilis is negative);
• + (such a response is interpreted as doubtful, one + evaluates a mild delay in hemolysis);
• ++ (observed with a partial delay in hemolysis and is regarded as a weakly positive Wasserman reaction);
• +++ (this result is regarded as a positive RW, indicating a significant delay in hemolysis);
• ++++ (a sharply positive RW, the complete absence of hemolysis and precipitation indicates that the patient has syphilis or other diseases that caused a false positive RW).

The first response indicates a negative RW and does not require further investigation. When obtaining other results, it should be borne in mind that the Wasserman reaction is not highly accurate and specific.

Attention. When conducting a blood test for the Wasserman reaction, false positive results are often observed.

In this regard, when receiving doubtful, weakly positive and sharply positive Wasserman reactions, treponemal tests are performed to clarify the diagnosis.

False positive results may be associated with fatty foods, alcohol, pregnancy, menstruation, malaria, systemic lupus erythematosus, etc.

Modern understanding of the Wassermann reaction

In modern laboratories, the "classical" Wassermann reaction is considered obsolete and is not used. However, RW is still often written on the answer sheet and prescription form.

Currently, this term refers to modified modern RWs.

The most common analogue of the Wasserman reaction is RPR (non-specific antiphospholipid test). It is also classified as a non-treponemal test (that is, it does not have high specificity), but is more sensitive and has a lower risk of false positive results than the classic Wasserman test.

The RPR test is a screening test that detects antibodies (IgG and IgM) to cardiolipin.

For analysis, as well as for the classical Wassermann reaction, venous blood is used.

It is desirable to take the analysis on an empty stomach. Smoking is excluded one hour before blood sampling. Although the risk of false-positive results is lower with RPR than with RW, it is ideally preferable not to consume alcohol or fatty foods the day before the test.

Where to donate blood and how much does the examination cost?

For reference. The estimated cost of RPR is from 330 to 400 rubles and depends on the laboratory in which the tests are taken.

Also, a specific treponemal test (TPHA or IgG / IgM ELISA for syphilis) can be used. This test detects in the blood specific antibodies exclusively to Treponema pallidum, so it can be used to clarify the results after non-treponemal tests. Its cost ranges from 320 to 380 rubles.

Indications for research

A positive RPR can be detected as early as seven to ten days after the patient develops a primary chancre or three to five weeks after infection.

The Wasserman reaction has a sensitivity of 70 to 80% in the diagnosis of primary syphilis and almost one hundred percent sensitivity in early latent and secondary syphilis.

After the onset of the secondary stage, the titers begin to decline. It should be taken into account that about thirty percent of late syphilis may be false negative for RPR.

Therefore, conducting treponemal tests, in order to clarify the diagnosis, is mandatory.

However, the Wasserman reaction (RPR) can be used effectively to control the ongoing treatment of syphilis.

The main indications for analysis are:

• casual sex;
• drug use;
• contact with a patient with syphilis;
• suspicion of syphilis (most specific is the appearance of a hard chancre);
• control of syphilis treatment;
• pregnancy, donation, work in medical institutions (included in the list of standard examinations);
• mental disorders and damage to the nervous system (neurosyphilis).

Also, children born from infected mothers are subject to mandatory examination.

Analysis during pregnancy

False positive Wasserman reaction. The reasons

Important. When conducting an initial examination, it should be borne in mind that non-treponemal tests do not have specificity. This is due to the fact that antibodies to cardiolipin can appear not only when infected with syphilis.

Most often, a false positive Wasserman reaction is detected in patients with:

• DM (diabetes mellitus);
• tuberculosis;
• malignant neoplasms;
• autoimmune pathologies (systemic damage to the connective tissue);
• viral hepatitis;
• enterovirus infection;
• severe pneumonia;
• infectious mononucleosis;
• scarlet fever;
• malaria;
• gout;
• alcoholism;
• (with syphilis previously ruled out (using a treponemal test), RW can be used to confirm this syndrome);
• eosinophilic infiltrate in the lungs.

Also, false positive results are possible in children on the seventh to tenth day of life, pregnant women, patients after vaccination and carriers of non-syphilitic treponema. In people taking narcotic drugs, the Wasserman reaction will also be false positive.

It should also be borne in mind that with a very high titer of syphilitic antibodies, false negative results can be diagnosed.

In this regard, RW should be carried out in combination, using specific treponemal tests. The most commonly used ELISA or RPGA to Treponema pallidum IgG / IgM,

Positive Wasserman reaction

A positive RPR is observed in syphilis:

• primary (if the infection occurred from one to three months ago);
• secondary (infection - more than three months ago);
• tertiary (infection - more than three years ago).

Also, a positive response can be detected within a year after the treatment and during the formation of seroresistance (also after treatment).

If a negative response is obtained, early seronegative primary or late tertiary disease cannot be ruled out.

Syphilis is a common sexually transmitted disease, if it is not detected in time, the body will be seriously damaged and death is possible. The Wasserman reaction is a special analysis that should be done if this pathology is suspected, timely diagnosis will help to immediately cure the disease with a positive result. You can become infected with syphilis not only through sexual contact, but also through household items, hygiene products, bedding.

Methods for diagnosing syphilis

Tests should identify the main causative agent of the disease - treponema pallidum, which is also pale treponema. To do this, on an empty stomach, blood is taken for a serological analysis. Such a study is considered to be the main type of laboratory diagnostics for the detection of syphilis. The most common research methods are:

• blood test for RV (RW) - Wasserman analysis;
• RPHA - passive hemagglutination reaction;
• ELISA - enzyme immunoassay;
• RIF - immunofluorescence reaction;
• RPR, microprecipitation reaction with cardiolipin antigen;
• RIBT - reaction of immobilization of pale treponemas.

What is the Wasserman reaction

This is a laboratory blood test for syphilis, which is aimed at determining the immunological response to the penetration of the pathogen into the body. In the human body, characteristic processes begin when infected. The causative agent of the disease contains the antigen cardiolipin. The patient's blood serum, due to the presence of reagins in it, enters into a complement fixation reaction. As a result, a specific complex with this antigen is obtained, which is capable of detecting RV.

When infected with syphilis, a person will certainly have antibodies to pale treponema in the blood, which is characterized as a physiological response of the immune system. During the test, the drug cardiolipin is added to the collected blood. If the causative agent of syphilis is already in the body, as a result, RSK will be visible, which binds the injected antigen and antibodies. In decoding, the number of signs "+" indicates the intensity of the formation of complexes or "-" in their absence.

Indications for research

It is recommended to regularly conduct a complete blood count in order to detect any abnormalities in the human body in time, at an early stage, setting up a reaction can significantly increase the effectiveness of treatment. For serum donation to RW, there are the following indications:

1. During professional examinations, medical examinations on a regular basis for employees of trade, medicine, education.
2. During pregnancy. There is a possibility of infection of the fetus with syphilis in the womb, so it is important to identify the result of the Wasserman analysis in women who plan to have a baby or are already carrying it. Pathology can cause serious harm to the baby.
3. People who have had long-term contact with pathology at work or at home.
4. If a person suffers from alcoholism or drug addiction.
5. With urgent hospitalization of a patient with signs of syphilis.
6. After intimacy without using a contraceptive with a random person.
7. All those wishing to become a blood or sperm donor must undergo a check.
8. If the pregnancy was terminated unnaturally.
9. Conduct a test during and after serving time in prison.
10. The reason for the RV is the hospitalization of a patient with enlarged nodes of the lymphatic system and fever.

Blood for the Wasserman reaction during pregnancy

This is the initial test that your OB/GYN will ask you to take. A blood test for the Wasserman reaction may be inaccurate, because the condition of the woman during this period affects the results. According to statistics, 32% of cases show a false positive result. If there is a “+” in the decoding, it is necessary to undergo a differential diagnosis. It is recommended to perform the test once per trimester, regardless of the presence or absence of sexual contact. There are no contraindications for RW for pregnant women; this is a standard material sampling.

Training

Some tests require specific preparation before passing. Wasserman's analysis will be as reliable as possible if you do not drink any alcoholic beverages (even low-alcohol ones) 2 days before the examination. It is recommended not to eat fatty foods during the same period, so as not to distort the results. It is impossible to take any digitalis preparations during preparation for RV.

How is the procedure carried out

Blood for the Wasserman reaction is carried out only on an empty stomach, this is an important condition. The last meal before sampling should be no later than 6 hours. The employee who performs the manipulations sits the client on a chair or lays him down on the couch. The analysis requires 8-10 ml of blood or cubital vein. If the study is carried out on a small child, then the material can be taken from the jugular or cranial vein.

How many days is a blood test done on RW

There are two stages in the study of the material. Wasserman's express test will be ready in 2 hours, but it can only confirm or deny the presence of syphilis antibodies in a patient. To obtain quantitative information on the state of the blood, the concentration of antibodies to treponema, you need from 1 to 7 days. The duration of the analysis and interpretation depends on the laboratory, the number of current analyzes.

Decryption

A blood test according to Wasserman should be deciphered only by a qualified doctor. The results may indicate not only a negative or positive reaction, but also an intermediate one. Only a specialist will be able to correctly interpret the data and not frighten the patient ahead of time. A typical negative result is indicated by a “-” sign and indicates the undoubted absence of syphilis in the human body.

positive reaction

When assessing the concentration of antibodies, a positive manifestation can be noted by one, two, three or four pluses. The decryption may contain the following designations:

1. "+" and "++" - the result indicates a dubious, weakly positive microreaction. Additional diagnostic tests and examinations are needed. You can repeat the analysis of August Wasserman after some time, because there is no complete certainty in the absence or presence of syphilis. The reason for this result may be a violation of the preparatory procedures before donating blood.
2. "+++" - positive reaction. Additional or reconfirmation is not required, the patient has syphilis and should undergo a full examination. Women are prescribed a smear from the vagina or uterus, men donate material from the urethra. Such a result is rarely erroneous, but clarifying tests may be prescribed if the patient's symptoms are similar to other diseases.
3. "++++" - the final positive result. High reaction intensity.
4. "++++" is the final positive reaction. The result obtained is 100% reliable and does not require any additional tests. The diagnosis is syphilis.

False positive Wasserman reaction

An absolutely healthy person can receive such an answer, this happens for specific reasons. This reaction occurs if the patient has acute or chronic stages of the disease, recent vaccinations, or recent physical injuries. All these conditions lead to the active production of a non-specific protein in the body, which is called antibodies or immunoglobulin. RW analysis aims to identify these proteins and recognize them as syphilitic. This becomes the basis for obtaining a false positive result.

The reasons

It was described above why a patient may receive a false positive result when testing for syphilis. Here is a list of conditions that can lead to this:

• myocardial infarction;
• alcohol, food poisoning;
• acute, chronic liver pathologies, hepatitis D, C, B;
• soft tissue or bone injuries;
• age-related changes in the work of the patient's body;
• tuberculosis;
• autoimmune diseases.

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