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[The discordant results in serum through reverse syphilis screening algorithm].

Shu-qin Dai1, Jun-ye Wang1, Xin Zheng1

  • 1State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center,Guangzhou 510060, China.

Zhonghua Liu Xing Bing Xue Za Zhi = Zhonghua Liuxingbingxue Zazhi
|January 1, 2014
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Summary

Reverse sequence syphilis screening in China revealed many discordant results where treponemal tests were positive but nontreponemal tests were negative. This suggests a need to optimize screening algorithms for improved accuracy in low-prevalence populations.

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Area of Science:

  • Infectious Diseases
  • Clinical Diagnostics
  • Epidemiology

Context:

  • Syphilis screening programs increasingly use reverse sequencing algorithms.
  • Discordant results (positive treponemal, negative nontreponemal tests) are emerging challenges.
  • Understanding these discordant results is crucial for accurate syphilis diagnosis in low-prevalence settings.

Purpose:

  • To analyze discordant results in a low syphilis prevalence population in China using a reverse sequence screening algorithm.
  • To evaluate the performance of ELISA, TPPA, and TRUST in identifying syphilis.
  • To provide evidence for improving syphilis screening protocols.

Summary:

  • A retrospective analysis of 21,049 serum samples using ELISA, TPPA, and TRUST revealed significant discordant results.
  • A high rate of negative nontreponemal tests (TRUST) was observed in samples with positive treponemal tests (TPPA).
  • False positivity rates varied significantly depending on the testing sequence.

Impact:

  • The study highlights the limitations of current reverse sequence syphilis screening algorithms.
  • Recommendations are made for a revised algorithm, prioritizing TPPA followed by quantitative TRUST for confirmed positives.
  • Optimizing the screening process can reduce false positives and improve diagnostic efficiency for syphilis.