Three Cases of Possible Late Syphilis with Negative Treponema Immobilization Test.

Although the treponema immobilization test (TPI) is often an essential requirement in reaching a diagnosis, and as soon as facilities permit should be done in every case of syphilis, it is not inviolable. It would be wrong, for example, to delay treatment in an otherwise undoubted case of syphilitic optic atrophy or general paralysis of the insane simply to await the results of this test. Equally, in an otherwise adequately treated case, a persistently positive TPI is not at present an indication for further treatment. Conversely, indications for treatment may exist with a negative TPI, as in the three following cases (all under my care) at the Royal Infirmary, Chester, between 1956 and 1962 inclusive.