Syphilis

Reactor Grids for Prioritizing Syphilis Investigations: Are Primary Syphilis Cases Being Missed?

“…In the early 1960s, many states made positive serologic tests for syphilis reportable as part of their syphilis control efforts. 4 Files of test results were established to allow programs to manually identify new cases and interpret future results. Due to the overwhelming volume of incoming tests, programs developed administrative procedures to prioritize tests for further investigations, with the goal of identifying the reactive serologic results most likely to result in new cases.…”

“…However, as automated electronic laboratory reporting increased, 9,10 case reporting by health providers has become less common. 4,11 Reactive tests are assigned for follow-up or are administratively closed without investigation based primarily on the likelihood of yielding a new infection. In theory, this likelihood is determined by periodically investigating all reported tests to determine how many new infections would have been missed because investigations were closed by the grid.…”

Going Off Grid: Modeling an Automated Record Search to Process Electronically Reported Reactive Nontreponemal Syphilis Tests

“…Over this same timeframe, technology and methods have evolved to assist in improving surveillance quality and efficiency 4 – 6 Syphilis case reporting began with providers reporting cases to health departments using paper records. Regular reporting of reactive syphilis serologies was added to health department syphilis reactor programs in 1962 to improve identification of syphilis cases 7 . As paper-based syphilis serology reporting became more prevalent, sexually transmitted disease (STD) programs including Florida needed to efficiently triage these results before conducting time-consuming record searches.…”

“…Syphilis reactor grids prioritized high-titer and younger individuals for syphilis investigations and others were closed without further investigation 3 . While these grids reduce disease intervention specialist (DIS) investigations, they vary from program to program, should be regularly evaluated and depending on their implementation could result in an underreporting (3% to 66%) of the true syphilis burden within a jurisdiction 7 – 12 . Moreover, many STD programs now have electronic databases that contain all of a patient’s past positive serologic test results from their jurisdictions.…”

“…Each field record is assigned to a DIS for further investigation and at least 1 supervisor for quality assurance review and reporting. A common limitation of reactor grids is the inability to account for a patient’s previous syphilis tests, which are needed to distinguish past from current syphilis infections 7 , 8 , 10 …”