Syphilis in patients with Hansen's disease

Between 1975 and 1979, 630 patients with leprosy of Hansen's disease (HD) were examined clinically and screened for syphilis using both the rapid plasma reagin (RPR) and fluorescent treponemal antibody absorption (FTA-ABS) tests. Seropositive syphilis was found more frequently than in the general population; 10% were true positive reactors with a reactive RPR, a reactive FTA-ABS, and historical, clinical, and/or postmortem evidence of syphilis. Only 8% exhibited false positive tests for reagin with a negative FTA-ABS and neither historical nor clinical evidence of treponemal infection. Among those with FTA-ABS test reactivity, highly positive FTA-ABS immunofluorescence (+3, +4) was highly predictive for syphilis (94.7%). Seropositive HD patients with both RPR and FTA-ABS reactivity should be seriously evaluated for syphilis and, if not yet treated, they should be treated.