Single-test syphilis serology: A case of not seeing the forest for the trees.

Autor: Zulu EM; Right to Care Zambia, Lusaka, Zambia., Herlihy JM; Department of Pediatrics, Boston Medical Center, Boston University, Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America.; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America., Duffy CR; Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America., Mwananyanda L; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America., Chilengi R; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia., Forman L; Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, United States of America., Heeren T; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America., Gill CJ; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America., Chavuma R; Right to Care Zambia, Lusaka, Zambia., Payne-Lohman B; Institute for Immunology and Informatics, University of Rhode Island, Kingston, Rhode Island, United States of America., Thea DM; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2024 May 09; Vol. 19 (5), pp. e0303253. Date of Electronic Publication: 2024 May 09 (Print Publication: 2024).
DOI: 10.1371/journal.pone.0303253
Abstrakt: Introduction: There have been few empirical studies for diagnostic test accuracy of syphilis using a sequence of rapid tests in populations with low prevalence of syphilis such as pregnant women. This analysis describes syphilis test positivity frequency among pregnant women at an antenatal clinic in Zambia using a reverse-sequence testing algorithm for antenatal syphilis screening.
Methods: Between August 2019 and May 2023, we recruited 1510 pregnant women from a peri-urban hospital in Lusaka, Zambia. HIV positive and HIV negative women were enrolled in a 1:1 ratio. Blood collected at recruitment from the pregnant mothers was tested on-site for syphilis using a rapid treponemal test. Samples that tested positive were further tested at a different laboratory, with rapid plasma reagin using archived plasma.
Results: Of the total 1,421 sera samples which were screened with a rapid treponemal test, 127 (8.9%) were positive and 1,294 (91.1%) were negative. Sufficient additional samples were available to perform RPR testing on 114 of the 127 (89.8%) RDT positive specimens. Thirty-one (27.2%) of these 114 were reactive by RPR and 83 (72.8%) were negative, resulting in a syphilis overtreatment rate of 3 fold (i.e, 84/114). Insufficient sample or test kit availability prevented any testing for the remaining 89 (5.9%) participants.
Conclusion: Use of only treponemal tests in low prevalence populations, like pregnant women, subjects individuals with non-active syphilis to the costs and possible risks of overtreatment. The use of the dual treponemal and non-treponemal tests would minimize this risk at some additional cost.
Competing Interests: The authors declare no competing interests.
(Copyright: © 2024 Zulu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje