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November 28, 1994

Use of Nontreponemal Tests in the Diagnosis of Syphilis-Reply

Author Affiliations

Decatur, Ga

Arch Intern Med. 1994;154(22):2616. doi:10.1001/archinte.1994.00420220116015

Ross and Young indicate, as did Haslett and Laverty in their letter to the editor published in the July 25th, 1994, issue of the Archives,1 that the prozone phenomenon in syphilis is being recognized more frequently. We agree with Ross and Young that case 1 probably represents a case of the prozone phenomenon, as the patient's infection was clearly beyond the primary stage (the late nontreponemal seroconversion seen in primary syphilis would have been another possible explanation). Because of the stated low prevalence (1% to 2%) of the prozone phenomenon in syphilis,2,3 we believe that its inclusion as part of the standard nontreponemal testing is probably not warranted; rather, prozone should be considered in the setting of a clinically highly suspicious case with a negative undiluted nontreponemal test result. However, the prevalence of the prozone phenomenon needs to be reevaluated in the setting of the more sophisticated and

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