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. 2019 Mar 5;68(6):913-918.
doi: 10.1093/cid/ciy558.

Performance of Treponemal Tests for the Diagnosis of Syphilis

Ina U Park  1   2 , Yetunde F Fakile  2 , Joan M Chow  1 , Kathleen J Gustafson  1 , Heather Jost  2 , Jeffrey M Schapiro  3 , Susan Novak-Weekley  4 , Anthony Tran  5 , Jim H Nomura  6 , Victor Chen  6 , Manie Beheshti  6 , Townson Tsai  6 , Karen Hoover  2 , Gail Bolan  2
Affiliations

Performance of Treponemal Tests for the Diagnosis of Syphilis

Ina U Park et al. Clin Infect Dis. .

Abstract

Background: Treponemal immunoassays are increasingly used for syphilis screening with the reverse sequence algorithm. There are few data describing performance of treponemal immunoassays compared to traditional treponemal tests in patients with and without syphilis.

Methods: We calculated sensitivity and specificity of 7 treponemal assays: (1) ADVIA Centaur (chemiluminescence immunoassay [CIA]); (2) Bioplex 2200 (microbead immunoassay); (3) fluorescent treponemal antibody absorption test (FTA-ABS); (4) INNO-LIA (line immunoassay); (5) LIAISON CIA; (6) Treponema pallidum particle agglutination assay (TPPA); and (7) Trep-Sure (enzyme immunoassay [EIA]), using a reference standard combining clinical diagnosis and serology results. Sera were collected between May 2012-January 2013. Cases were characterized as: (1) current clinical diagnosis of syphilis: primary, secondary, early latent, late latent; (2) prior treated syphilis only; (3) no evidence of current syphilis, no prior history of syphilis, and at least 4 of 7 treponemal tests negative.

Results: Among 959 participants, 262 had current syphilis, 294 had prior syphilis, and 403 did not have syphilis. FTA-ABS was less sensitive for primary syphilis (78.2%) than the immunoassays or TPPA (94.5%-96.4%) (all P ≤ .01). All immunoassays were 100% sensitive for secondary syphilis, 95.2%-100% sensitive for early latent disease, and 86.8%-98.5% sensitive in late latent disease. TPPA had 100% specificity.

Conclusions: Treponemal immunoassays demonstrated excellent sensitivity for secondary, early latent, and seropositive primary syphilis. Sensitivity of FTA-ABS in primary syphilis was poor. Given its high specificity and superior sensitivity, TPPA is preferred to adjudicate discordant results with the reverse sequence algorithm over the FTA-ABS.

Keywords: diagnostic performance; immunoassay; syphilis; treponemal.

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References

    1. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2016 US Department of Health and Human Services, Atlanta, GA, 2017.
    1. Creegan L, Bauer HM, Samuel MC, Klausner J, Liska S, Bolan G. An evaluation of the relative sensitivities of the venereal disease research laboratory test and the Treponema pallidum particle agglutination test among patients diagnosed with primary syphilis. Sex Transm Dis 2007; 34(12): 1016–8. - PubMed
    1. Nandwani R, Evans DT. Are you sure it’s syphilis? A review of false positive serology. Int J STD AIDS 1995; 6(4): 241–8. - PubMed
    1. Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR 2015; 64(RR-03): 1–137. - PMC - PubMed
    1. Park IU, Chow JM, Bolan G, Stanley M, Shieh J, Schapiro JM. Screening for syphilis with the treponemal immunoassay: analysis of discordant serology results and implications for clinical management. J Infect Dis 2011; 204(9): 1297–304. - PubMed

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