title: Case report and evaluation of the frequency of the prozone phenomenon in syphilis serology - an infrequent but important laboratory phenomenon.
abstract: BACKGROUND
  Treponema pallidum specific serology generally remains reactive for life. Therefore, the diagnosis of syphilis reinfection relies on clinical assessment and nontreponemal (reagin) serologic testing. The prozone phenomenon can lead to a falsely nonreactive rapid plasma reagin (RPR) assay result.
  
  
  METHODS
  We report a case of secondary syphilis in a HIV infected patient with a previous history of syphilis infection, where a falsely nonreactive RPR assay was associated with a delayed diagnosis of reinfection and infectious syphilis. The prozone phenomenon was detected in several of the patient's serum samples collected around this time. We subsequently undertook a prospective evaluation for the prozone phenomenon in 3222 consecutive sera, which were assayed using the RPR assay for clinical purposes over a 10-month period.
  
  
  RESULTS
  The overall rate of the prozone phenomenon was 2 out of 3222 samples (0.06%; 95% confidence interval (CI): 0.02-0.22%) and the rate per reactive sample was 2 out of 397 (0.5%; 95% CI: 0.14-1.81%).
  
  
  CONCLUSIONS
  Clinicians should request RPR testing at dilutions of sera when syphilis is suspected clinically and the RPR assay is nonreactive.
authors.affiliation: Department of Infectious Diseases, Prince of Wales Hospital, Randwick, Australia. Jeffrey.Post@sesiahs.health.nsw.gov.au
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Post
authors.forename: Candice
authors.initials: C
authors.lastname: Khor
authors.forename: Virginia
authors.initials: V
authors.lastname: Furner
authors.forename: Don E
authors.initials: DE
authors.lastname: Smith
authors.forename: L Ross
authors.initials: LR
authors.lastname: Whybin
authors.forename: Peter W
authors.initials: PW
authors.lastname: Robertson
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology / Q000635:transmission; D000328:Adult; D019969:Amphetamine-Related Disorders / Q000175:diagnosis / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005189:False Positive Reactions; D006801:Humans; D008297:Male; D009517:New South Wales; D010402:Penicillin G Procaine / Q000627:therapeutic use; D011446:Prospective Studies; D012008:Recurrence; D012747:Sexual Partners; D013587:Syphilis / Q000175:diagnosis* / Q000453:epidemiology / Q000635:transmission; D013588:Syphilis Serodiagnosis / Q000706:statistics & numerical data*; D019562:Viral Load
chemical_list: D000900:Anti-Bacterial Agents; D010402:Penicillin G Procaine