Abstract
Objectives: To assess the rapid plasma reagin (RPR) test performance in the field and to evaluate a new rapid syphilis test (RST) as a primary screen for syphilis.
Methods: 1325 women of reproductive age from rural communities in the Gambia were tested for syphilis seropositivity using a RPR 18 mm circle card and a RST strip. Within 1 week a repeat RPR and a TPHA test were carried out using standard techniques in the laboratory.
Results: Comparing field tests to a diagnosis of "active" syphilis defined as laboratory RPR and TPHA positive, the RPR test was 77.5% sensitive and 94.1% specific; the RST was 75.0% sensitive and 95.2% specific. The RST was easier to use and interpret than the RPR test especially where field conditions were difficult. In this setting with a low prevalence of syphilis in the community (3%), the chance of someone with a positive test being confirmed as having serologically active syphilis was less than 50% for both tests.
Conclusions: The appropriateness of syphilis screening using RPR testing in antenatal clinics and health centres should be questioned if there is a low prevalence in the population, conditions for testing are poor, and resources limited. There is still an urgent need for an appropriate rapid syphilis test for field use.
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Selected References
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- Berkowitz K., Baxi L., Fox H. E. False-negative syphilis screening: the prozone phenomenon, nonimmune hydrops, and diagnosis of syphilis during pregnancy. Am J Obstet Gynecol. 1990 Sep;163(3):975–977. doi: 10.1016/0002-9378(90)91107-n. [DOI] [PubMed] [Google Scholar]
- Delport S. D. On-site screening for maternal syphilis in an antenatal clinic. S Afr Med J. 1993 Oct;83(10):723–724. [PubMed] [Google Scholar]
- Hawkes S., Morison L., Foster S., Gausia K., Chakraborty J., Peeling R. W., Mabey D. Reproductive-tract infections in women in low-income, low-prevalence situations: assessment of syndromic management in Matlab, Bangladesh. Lancet. 1999 Nov 20;354(9192):1776–1781. doi: 10.1016/s0140-6736(99)02463-0. [DOI] [PubMed] [Google Scholar]
- Jenniskens F., Obwaka E., Kirisuah S., Moses S., Yusufali F. M., Achola J. O., Fransen L., Laga M., Temmerman M. Syphilis control in pregnancy: decentralization of screening facilities to primary care level, a demonstration project in Nairobi, Kenya. Int J Gynaecol Obstet. 1995 Jun;48 (Suppl):S121–S128. doi: 10.1016/0020-7292(95)02326-8. [DOI] [PubMed] [Google Scholar]
- Larsen S. A., Steiner B. M., Rudolph A. H. Laboratory diagnosis and interpretation of tests for syphilis. Clin Microbiol Rev. 1995 Jan;8(1):1–21. doi: 10.1128/cmr.8.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schmidt B. L., Edjlalipour M., Luger A. Comparative evaluation of nine different enzyme-linked immunosorbent assays for determination of antibodies against Treponema pallidum in patients with primary syphilis. J Clin Microbiol. 2000 Mar;38(3):1279–1282. doi: 10.1128/jcm.38.3.1279-1282.2000. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Shaw M., van der Sande M., West B., Paine K., Ceesay S., Bailey R., Walraven G., Morison L., McAdam K. Prevalence of herpes simplex type 2 and syphilis serology among young adults in a rural Gambian community. Sex Transm Infect. 2001 Oct;77(5):358–365. doi: 10.1136/sti.77.5.358. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sonke G. S., Kiemeney L. A. Diagnostic research in benign prostatic hyperplasia--from sensitivity to neural networks. Curr Opin Urol. 1999 Jan;9(1):31–37. doi: 10.1097/00042307-199901000-00006. [DOI] [PubMed] [Google Scholar]
- Van Dyck E., Van de Velden L., Ndoye I., Piot P., Meheus A. Evaluation of the rapid plasma reagin "teardrop" card test for screening of syphilis in field conditions. Sex Transm Dis. 1993 Jul-Aug;20(4):194–197. doi: 10.1097/00007435-199307000-00003. [DOI] [PubMed] [Google Scholar]
- Walraven G., Scherf C., West B., Ekpo G., Paine K., Coleman R., Bailey R., Morison L. The burden of reproductive-organ disease in rural women in The Gambia, West Africa. Lancet. 2001 Apr 14;357(9263):1161–1167. doi: 10.1016/S0140-6736(00)04333-6. [DOI] [PubMed] [Google Scholar]
- Young H. Guidelines for serological testing for syphilis. Sex Transm Infect. 2000 Oct;76(5):403–405. doi: 10.1136/sti.76.5.403. [DOI] [PMC free article] [PubMed] [Google Scholar]
- el-Zaatari M. M., Martens M. G. False-negative syphilis screening due to change in temperature. Sex Transm Dis. 1994 Sep-Oct;21(5):243–246. doi: 10.1097/00007435-199409000-00001. [DOI] [PubMed] [Google Scholar]