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May 21, 1973

Diagnostic Significance of Positive Syphilis Tests

JAMA. 1973;224(8):1187. doi:10.1001/jama.1973.03220220085023

To the Editor.—  Dr. Nicholas J. Fiumara's reply (223:1167, 1973) to a question regarding positive VDRL tests in a 20-year-old virgin woman does not appear to me to be entirely consistent with the information provided in the query. The repeated VDRL tests positive in low titer are as consistent with latent syphilis as with a biological false-positive reaction. The FTA-ABS tests were positive on two occasions and negative on two others. If truly positive, the FTA-ABS test would confirm a diagnosis of syphilis indicating lumbar puncture and adequate treatment. If truly negative, the FTA-ABS test would rule out syphilis and indicate further investigation, especially in terms of autoimmune disease as Dr. Fiumara suggests. Aside from the unique and recognizable beaded pattern "false positive" found in lupus erythematosus,1 the FTA-ABS test is highly specific for syphilis.Confirmation of the status of the FTA-ABS test and possible use of a second specific