Metaanalysis of the Performance of a Combined Treponemal and Nontreponemal Rapid Diagnostic Test for Syphilis and Yaws

Marks, Michael; Yin, Yuyao; Chen, Xiang Sheng; Castro, Arnold R.; Causer, Louise; Guy, Rebecca; Wangnapi, Regina; Mitjà, Oriol; Aziz, Abdul; Castro, Rogério; Pereira, Filomena; Taleo, Fasihah; Guinard, Jérôme; Bélec, Laurent; Ye, Tun; Bottomley, Christian; Ballard, Ronald C.; Mabey, David

doi:10.1093/cid/ciw348

Cited by 53 publications

(49 citation statements)

References 25 publications

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“…To reduce overtreatment, especially in high‐prevalence populations (>5%), an initial RDT is performed and, if positive, this is followed by a rapid plasma reagin (RPR) test, which detects non‐TP antibodies, indicating an active infection. If the RPR test is reactive, treatment for syphilis is provided . However, the uptake of the sequential RPR test is unknown in many resource‐constrained settings.…”

Section: Resultsmentioning

confidence: 99%

Diagnosing sexually transmitted infections in resource‐constrained settings: challenges and ways forward

Ndowa²,

et al. 2019

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Introduction Sexually transmitted infections (STIs) remain prevalent and are increasing in several populations. Appropriate STI diagnosis is crucial to prevent the transmission and sequelae of untreated infection. We reviewed the diagnostic accuracy of syndromic case management and existing point‐of‐care tests (POCTs), including those in the pipeline, to diagnose STIs in resource‐constrained settings. Methods We prioritized updating the systematic review and meta‐analysis of the diagnostic accuracy of vaginal discharge from 2001 to 2015 to include studies until 2018. We calculated the absolute effects of different vaginal flowcharts and the diagnostic performance of POCTs on important outcomes. We searched the peer‐reviewed literature for previously conducted systematic reviews and articles from 1990 to 2018 on the diagnostic accuracy of syndromic management of vaginal and urethral discharge, genital ulcer and anorectal infections. We conducted literature reviews from 2000 to 2018 on the existing POCTs and those in the pipeline. Results and discussions The diagnostic accuracy of urethral discharge and genital ulcer disease syndromes is relatively adequate. Asymptomatic Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections limit the use of vaginal discharge and anorectal syndromes. The pooled diagnostic accuracy of vaginal syndromic case management for CT/NG is low, resulting in high numbers of overtreatment and missed treatment. The absolute effect of POCTs was reduced overtreatment and missed treatment. Findings of the reviews on syndromic case management underscored the need for low‐cost and accurate POCTs for the identification, first, of CT/NG, and, second, of Mycoplasma genitalium (MG) and Trichomonas vaginalis (TV) and NG and MG resistance/susceptibility testing. Near‐patient POCT molecular assays for CT/NG/TV are commercially available. The prices of these POCTs remain the barrier for uptake in resource‐constrained settings. This is driving the development of lower cost solutions. Conclusions The WHO syndromic case management guidelines should be updated to raise the quality of STI management through the integration of laboratory tests. STI screening strategies are needed to address asymptomatic STIs. POCTs that are accurate, rapid, simple and affordable are urgently needed in resource‐constrained settings to support the uptake of aetiological diagnosis and treatment.

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Section: Resultsmentioning

confidence: 99%

Diagnosing sexually transmitted infections in resource‐constrained settings: challenges and ways forward

Ndowa²,

et al. 2019

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“…Antibodies to a non-treponemal antigen, which appears with infection and declines in the months after successful treatment, are used in a flocculation assay called the rapid plasma reagin assay, which can yield a result in 8 minutes but requires electricity to operate, a centrifuge for processing serum from whole blood, a shaker and cardiolipin as an antigen. A combination treponemal and non-treponemal rapid test has been developed in an immunochromatographic test in a lateral flow format with acceptable performance characteristics 51 .…”

Section: Factors Associated With Successful Assured Diagnosticsmentioning

confidence: 99%

REASSURED diagnostics to inform disease control strategies, strengthen health systems and improve patient outcomes

et al. 2018

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“…283,284 has good sensitivity and specificity for both treponemal (90·1-98·2% and 91·8-98·0%, 1399 respectively) and non-treponemal (80·6-98·2% and 89·4%, respectively) tests. 365 …”

mentioning

confidence: 99%

Sexually transmitted infections: challenges ahead

Unemo

Bradshaw

Hocking

et al. 2017

The Lancet Infectious Diseases

584

469

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Metaanalysis of the Performance of a Combined Treponemal and Nontreponemal Rapid Diagnostic Test for Syphilis and Yaws

Abstract: A combined treponemal and nontreponemal rapid diagnostic test was found to have good sensitivity and specificity for both syphilis and yaws. The performance of both the treponemal and nontreponemal test components was strongly associated with the rapid plasma reagin titer.

Cited by 53 publications

References 25 publications

Diagnosing sexually transmitted infections in resource‐constrained settings: challenges and ways forward

Diagnosing sexually transmitted infections in resource‐constrained settings: challenges and ways forward

REASSURED diagnostics to inform disease control strategies, strengthen health systems and improve patient outcomes

Sexually transmitted infections: challenges ahead

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