Syphilis testing in antenatal care: Policies and practices among laboratories in the Americas

Abstract

Objective: To asses laboratory syphilis testing policies and practices among laboratories in the Americas. Methods: Laboratory directors or designees from PAHO member countries were invited to participate in a structured, electronically-delivered survey between March and August, 2014. Data on syphilis tests, algorithms, and quality control (QC) practices were analyzed, focusing on laboratories receiving specimens from antenatal clinics (ANCs). Results: Surveys were completed by 69 laboratories representing 30 (86%) countries. Participating laboratories included 36 (52%) national or regional reference labs and 33 (48%) lower-level laboratories. Most (94%) were public sector facilities and 71% reported existence of a national algorithm for syphilis testing in pregnancy, usually involving both treponemal and non-treponemal testing (72%). Less than half (41%) used rapid syphilis tests (RSTs); and only seven laboratories representing five countries reported RSTs were included in the national algorithm for pregnant women. Most (83%) laboratories serving ANCs reported using some type of QC system; 68% of laboratories reported participation in external QC. Only 36% of laboratories reported data to national/local surveillance. Half of all laboratories serving ANC settings reported a stockout of one or more essential supplies during the previous year (median duration, 30 days). Conclusion: Updating laboratory algorithms, improving testing standards, integrating data into existing surveillance, and improved procurement and distribution of commodities may be needed to ensure elimination of MTCT of syphilis in the Americas.

Elimination of Congenital Syphilis in Ukraine: Analysis and the Emerging Issues

“…Besides, current requirements for confirmatory treponemal test, lead to a delay in the diagnosis and treatment of syphilis especially for women from risk group and rural areas [11]. The fact that in 81.4 % of pregnant women with syphilis partner notification was not made indicates a significant risk of spreading of syphilis in the general population and passive surveillance [12].…”

Syphilis testing practices in the Americas

“…Details of questions are previously described, [11] and (briefly) included information on syphilis tests used and number of tests conducted, commodities and equipment, testing algorithms, information on the technicians performing syphilis tests and challenges faced by laboratories. The questionnaire also asked about basic quality control (QC) and QA procedures used by the laboratories, including use of daily controls, availability of standard operating procedures for specific tests, type and extent of technician training on specific tests, laboratory participation in an external QA programme and periodic on-site evaluation aimed at assessing quality of testing.…”

“…Additional analyses assessed responses by subregion with countries grouped in the manner of previous PAHO reports, including North America (excluding Mexico), Central America (including Mexico), the Caribbean nations (Haiti, Guyana, Cuba and 12 other island nations), the Andean nations and the Southern Cone nations. We calculated proportions, means and medians values of variables using SAS version 9.3 and reported ranges where applicable [11].…”

The continuing threat of syphilis in pregnancy

“…Although this method of testing may lead to an increase in the number of false-positive results, reverse testing allows for higher throughput, can identify patients in all stages of disease, and has a higher sensitivity in early stages of the disease [13 && ]. It may result in faster and more accurate diagnosis and the potential for expedited treatment of the mother and fetus [14,15]. The performance of this strategy is relatively new and continues to be investigated in different populations at risk.…”