The Traditional or Reverse Algorithm for Diagnosis of Syphilis: Pros and Cons

Ortiz, Daniel A.; Shukla, Mayur; Loeffelholz, Michael J.

doi:10.1093/cid/ciaa307

Cited by 43 publications

(53 citation statements)

References 41 publications

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“…Clinical laboratories sometimes screen syphilis serologic samples by using automated treponemal immunoassays, typically by EIA or CIA ( 571 – 573 ). This reverse sequence algorithm for syphilis testing can identify persons previously treated for syphilis, those with untreated or incompletely treated syphilis, and those with false-positive results that can occur with a low likelihood of infection ( 574 ). Persons with a positive treponemal screening test should have a standard quantitative nontreponemal test with titer performed reflexively by the laboratory to guide patient management decisions.…”

Section: Syphilismentioning

confidence: 99%

Sexually Transmitted Infections Treatment Guidelines, 2021

Workowski¹,

Bachmann²,

Chan³

et al. 2021

MMWR Recomm. Rep.

1,720

2,621

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These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11-14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs. BOX 1. The Five P's approach for health care providers obtaining sexual histories: partners, practices, protection from sexually transmitted infections, past history of sexually transmitted infections, and pregnancy intention Additional information about external condoms is available at https://www.cdc.gov/condomeffectiveness. Internal CondomsCondoms for internal vaginal use, also known as female condoms, are available worldwide (e.g., the FC2 Female Condom, Reddy condom, Cupid female condom, and Woman's condom) (31,32). Use of internal condoms can provide protection from acquisition and transmission of STIs, although data are limited. Internal condoms are more costly compared with external condoms; however, they offer the advantage of being controlled by the receptive partner as an STI and HIV prevention method, and the newer versions might be acceptable to all persons. Although the internal condom also has been used during receptive anal intercourse, efficacy associated with this practice remains unknown (33). Additional information about the internal condom is available at http://www.ashasexualhealth. org/pdfs/Male_and_Female_Condoms.pdf. Cervical DiaphragmsIn observational studies, diaphragm use has been demonstrated to protect against cervical gonorrhea, chlamydia, and trichomoniasis (34). However, a trial examining the effect of a diaphragm plus lubricant on HIV acquisition among women in Africa reported no additional protective effect when compared with the use of male condoms alone. Likewise, no difference by study arm in the rate of acquisition of chlamydia, gonorrhea, or herpes occurred (35,36). Diaphragms should not be relied on as the sole source of protection against HIV and other STIs.

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Section: Syphilismentioning

confidence: 99%

Sexually Transmitted Infections Treatment Guidelines, 2021

Workowski¹,

Bachmann²,

Chan³

et al. 2021

MMWR Recomm. Rep.

1,720

2,621

View full text Add to dashboard Cite

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“…Though it has its own limitations. Importantly, initial setup costs and ongoing operational costs may be higher than those of the traditional algorithm ( Ortiz et al., 2020 ). Furthermore, a false-positive result may lead to potential overtreatment.…”

Section: Seroassays For Syphilismentioning

confidence: 99%

Laboratory Diagnostic Tools for Syphilis: Current Status and Future Prospects

Luo

Xie

Xiao

2021

Front. Cell. Infect. Microbiol.

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With the increasing number of patients infected with syphilis in the past 20 years, early diagnosis and early treatment are essential to decline syphilis prevalence. Owing to its diverse manifestations, which may occur in other infections, the disease often makes clinicians confused. Therefore, a sensitive method for detecting T. pallidum is fundamental for the prompt diagnosis of syphilis. Morphological observation, immunohistochemical assay, rabbit infectivity test, serologic tests, and nucleic acid amplification assays have been applied to the diagnosis of syphilis. Morphological observation, including dark-field microscopy, silver-staining, and direct fluorescent antibody staining for T. pallidum, can be used as a direct detection method for chancre specimens in primary syphilis. Immunohistochemistry is a highly sensitive and specific assay, especially in the lesion biopsies from secondary syphilis. Rabbit infectivity test is considered as a sensitive and reliable method for detecting T. pallidum in clinical samples and used as a historical standard for the diagnosis of syphilis. Serologic tests for syphilis are widely adopted using non-treponemal or treponemal tests by either the traditional or reverse algorithm and remain the gold standard in the diagnosis of syphilis patients. In addition, nucleic acid amplification assay is capable of detecting T. pallidum DNA in the samples from patients with syphilis. Notably, PCR is probably a promising method but remains to be further improved. All of the methods mentioned above play important roles in various stages of syphilis. This review aims to provide a summary of the performance characteristics of detection methods for syphilis.

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“…Реакція Вассермана (експрес-діагностика сифілісу) не використовується в Європі з 80-х років через низьку специфічність і чутливість. Характеристики сучасних ТТ і НТТ на сифіліс представлені в таблиці 2, з якої видно, що вони надають взаємодоповнюючі дані [6,[13][14][15][16].…”

Section: лабораторна діагностика сифілісу під час вагітностіunclassified

“…• реверсійний, коли первинно використовується ТТ, результат якого підтверджується НТТ, при дискордантних результатах додатково використовується інший ТТ [16].…”

Section: лабораторна діагностика сифілісу під час вагітностіunclassified

“…Недоліком традиційного підходу є ризик пропущення випадків недавнього інфікування. Реверсійний скринінг дозволяє виявити більшість випадків, що потребують лікування в популяціях із невисокою частотою сифілісу, його недоліком є гіпердіагностика [16][17][18][19]. Враховуючи те, що вагітність є фактором збільшення вірогідності хибнопозитивних результатів серологічних тестів на сифіліс (табл.…”

Section: лабораторна діагностика сифілісу під час вагітностіunclassified

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Change of emphasis in the structure of prenatal infections, or what is SCORTCH? Literature review

Тутченко

Бурка

Коломієць

et al. 2020

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Prenatal infections (PI) remain an actual problem. Taking into account the epidemiological data on the increase in the incidence of syphilis in many countries, a review of modern algorithms for diagnosing this disease in pregnant women and newborns has been carried out. Universal screening for syphilis at the first prenatal examination is recommended by WHO and CDC, and is practiced in most countries. The article also presents the characteristics of modern laboratory methods of serological screening of pregnant women for syphilis and their combinations, one of which is primary screening using the treponemal test “total antibodies to syphilis” with confirmation of a positive result by immunoblotting.Given the controversial nature of approaches to the prevention of other PI and their consequences, this review provides current recommendations for countries that screen and actively manage infections such as cytomegalovirus (CMV) and toxoplasmosis (T). Despite the proven significance of CMV as a factor in PI, universal prenatal screening, similar to screening for syphilis is not practiced in any of the countries due to the absence of prenatal treatment with proven efficacy. According to the national protocol of Germany, serostatus (titers IgG, IgM) to CMV are determined in early pregnancy. Confirmation of congenital CMV infection (HCMVI) is a positive PCR result in the amniotic fluid after 20–21 weeks of gestation. The main method of laboratory diagnostics of HCMVI in a newborn is PCR for CMV in urine. The article also presents the main approaches to the prevention of congenital toxoplasmosis, which have been practiced in France since the 90s and demonstrate effectiveness.Thus, despite the fact that the use of effective prenatal treatment is not possible for all PI, their diagnosis using a complex of modern laboratory and instrumental methods is critical for the child’s health, since it allows the application of an appropriate algorithm for specific treatment and observation from birth

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The Traditional or Reverse Algorithm for Diagnosis of Syphilis: Pros and Cons

Cited by 43 publications

References 41 publications

Sexually Transmitted Infections Treatment Guidelines, 2021

Sexually Transmitted Infections Treatment Guidelines, 2021

Laboratory Diagnostic Tools for Syphilis: Current Status and Future Prospects

Change of emphasis in the structure of prenatal infections, or what is SCORTCH? Literature review

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