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Comparison of automated treponemal and nontreponemal test algorithms as first-line syphilis screening assays.

Huh HJ, Chung JW, Park SY, Chae SL - Ann Lab Med (2016)

Bottom Line: Samples from 24,681 persons were included in this study.We routinely performed Mediace RPR and Mediace TPLA simultaneously.Among the 24,681 samples, 30 (0.1%) were found positive by traditional screening, and 190 (0.8%) by reverse screening.

View Article: PubMed Central - PubMed

Affiliation: Department of Laboratory Medicine, Dongguk University Ilsan Hospital, Goyang, Korea. hjhuh@duih.org.

ABSTRACT

Background: Automated Mediace Treponema pallidum latex agglutination (TPLA) and Mediace rapid plasma reagin (RPR) assays are used by many laboratories for syphilis diagnosis. This study compared the results of the traditional syphilis screening algorithm and a reverse algorithm using automated Mediace RPR or Mediace TPLA as first-line screening assays in subjects undergoing a health checkup.

Methods: Samples from 24,681 persons were included in this study. We routinely performed Mediace RPR and Mediace TPLA simultaneously. Results were analyzed according to both the traditional algorithm and reverse algorithm. Samples with discordant results on the reverse algorithm (e.g., positive Mediace TPLA, negative Mediace RPR) were tested with Treponema pallidum particle agglutination (TPPA).

Results: Among the 24,681 samples, 30 (0.1%) were found positive by traditional screening, and 190 (0.8%) by reverse screening. The identified syphilis rate and overall false-positive rate according to the traditional algorithm were lower than those according to the reverse algorithm (0.07% and 0.05% vs. 0.64% and 0.13%, respectively). A total of 173 discordant samples were tested with TPPA by using the reverse algorithm, of which 140 (80.9%) were TPPA positive.

Conclusions: Despite the increased false-positive results in populations with a low prevalence of syphilis, the reverse algorithm detected 140 samples with treponemal antibody that went undetected by the traditional algorithm. The reverse algorithm using Mediace TPLA as a screening test is more sensitive for the detection of syphilis.

No MeSH data available.


Related in: MedlinePlus

Serologic results and clinical management following the reverse syphilis screening algorithm.Abbreviations: RPR, rapid plasma regain; TPLA, Treponema pallidum latex agglutination; TPPA, Treponema pallidum particle agglutination.
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Figure 2: Serologic results and clinical management following the reverse syphilis screening algorithm.Abbreviations: RPR, rapid plasma regain; TPLA, Treponema pallidum latex agglutination; TPPA, Treponema pallidum particle agglutination.

Mentions: Six patients with positive Mediace RPR and Mediace TPLA results according to the traditional algorithm (64.7% of 17 patients) had a clinical follow-up after the health checkup. All six received antibiotic treatment; three had no documentation of prior treatment for syphilis, and three had a prior treatment history (Fig. 1). Thirty four patients with Mediace TPLA-positive, Mediace RPR-negative, and TPPA-positive results by using the reverse algorithm (24.3% of 140 patients) underwent a clinical follow-up after the health checkup. Of the 34 patients, 20 with a history of treated syphilis did not receive antibiotic treatment. Of 14 patients (41.2% of 34 patients) without history of syphilis, 10 received antibiotic treatment (Fig. 2).


Comparison of automated treponemal and nontreponemal test algorithms as first-line syphilis screening assays.

Huh HJ, Chung JW, Park SY, Chae SL - Ann Lab Med (2016)

Serologic results and clinical management following the reverse syphilis screening algorithm.Abbreviations: RPR, rapid plasma regain; TPLA, Treponema pallidum latex agglutination; TPPA, Treponema pallidum particle agglutination.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4697339&req=5

Figure 2: Serologic results and clinical management following the reverse syphilis screening algorithm.Abbreviations: RPR, rapid plasma regain; TPLA, Treponema pallidum latex agglutination; TPPA, Treponema pallidum particle agglutination.
Mentions: Six patients with positive Mediace RPR and Mediace TPLA results according to the traditional algorithm (64.7% of 17 patients) had a clinical follow-up after the health checkup. All six received antibiotic treatment; three had no documentation of prior treatment for syphilis, and three had a prior treatment history (Fig. 1). Thirty four patients with Mediace TPLA-positive, Mediace RPR-negative, and TPPA-positive results by using the reverse algorithm (24.3% of 140 patients) underwent a clinical follow-up after the health checkup. Of the 34 patients, 20 with a history of treated syphilis did not receive antibiotic treatment. Of 14 patients (41.2% of 34 patients) without history of syphilis, 10 received antibiotic treatment (Fig. 2).

Bottom Line: Samples from 24,681 persons were included in this study.We routinely performed Mediace RPR and Mediace TPLA simultaneously.Among the 24,681 samples, 30 (0.1%) were found positive by traditional screening, and 190 (0.8%) by reverse screening.

View Article: PubMed Central - PubMed

Affiliation: Department of Laboratory Medicine, Dongguk University Ilsan Hospital, Goyang, Korea. hjhuh@duih.org.

ABSTRACT

Background: Automated Mediace Treponema pallidum latex agglutination (TPLA) and Mediace rapid plasma reagin (RPR) assays are used by many laboratories for syphilis diagnosis. This study compared the results of the traditional syphilis screening algorithm and a reverse algorithm using automated Mediace RPR or Mediace TPLA as first-line screening assays in subjects undergoing a health checkup.

Methods: Samples from 24,681 persons were included in this study. We routinely performed Mediace RPR and Mediace TPLA simultaneously. Results were analyzed according to both the traditional algorithm and reverse algorithm. Samples with discordant results on the reverse algorithm (e.g., positive Mediace TPLA, negative Mediace RPR) were tested with Treponema pallidum particle agglutination (TPPA).

Results: Among the 24,681 samples, 30 (0.1%) were found positive by traditional screening, and 190 (0.8%) by reverse screening. The identified syphilis rate and overall false-positive rate according to the traditional algorithm were lower than those according to the reverse algorithm (0.07% and 0.05% vs. 0.64% and 0.13%, respectively). A total of 173 discordant samples were tested with TPPA by using the reverse algorithm, of which 140 (80.9%) were TPPA positive.

Conclusions: Despite the increased false-positive results in populations with a low prevalence of syphilis, the reverse algorithm detected 140 samples with treponemal antibody that went undetected by the traditional algorithm. The reverse algorithm using Mediace TPLA as a screening test is more sensitive for the detection of syphilis.

No MeSH data available.


Related in: MedlinePlus