Tuberculosis and Syphilis Screening


Tuberculosis and Syphilis Screening

Being Alive Newsletter, Being Alive/Los Angeles - March 1993
Robert S. Jenkins, M.D.

The Centers for Disease Control (CDC) recommend tuberculosis and syphilis testing of every HIV+ patient. The tests to detect these two diseases are simple to perform and important. Tuberculosis is making a resurgence in the United States and early detection and treatment is imperative for control of this disease. Syphilis is less common but equally devastating if not treated early.

Syphilis test: Serologic (blood) tests for syphilis are the most effective way of diagnosing syphilis. The RPR (Rapid Plasma Riagin) blood test is the standard test recommended. These should be repeated after the initial screening. This depends on one's sexual activity and your physician's clinical judgement.

Tuberculosis skin test: The CDC recommends that all HIV+ individuals be given a skin test with five tuberculin units of PPD (purified protein derivative). Any patient with a tuberculin reaction of greater than five millimeters induration (hard lump) should receive preventive isoniazid therapy (INH) for at least 12 months. Some HIV+ patients are "anergic" and thus unable to mount an immune response to the TB skin test. Thus, "anergy skin tests" are recommended. These tests involve the injections of small amounts of "dead" mumps, candida and/or tricophyton under the skin and then note the body's response (amount of enduration) to these. Mumps, candida and/or tricophyton are selected because everyone has been exposed to at least one of these three at sometime in their life and should mount an immune response if they are not anergic.

If one is "anergic" (unable to mount a skin response), then a chest X-ray is recommended. The PPD skin test for TB is recommended yearly to all HIV+ patients as is a yearly chest X-ray for those persons who are anergic.

(Robert S. Jenkins, MD, is a physician with the Pacific Oaks Medical Group. He can be reached at 310.652.2562)
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