Screening Veterans for Syphilis: Implementation of the Reverse Sequence Algorithm.

Area of Science:

• Infectious Diseases
• Clinical Diagnostics
• Public Health

Background:

• Syphilis remains a significant public health concern, necessitating accurate and efficient diagnostic algorithms.
• The reverse sequence algorithm (RSA) is increasingly used for syphilis screening.
• Effective interpretation of diagnostic results is crucial for timely patient management and disease control.

Purpose of the Study:

• To evaluate the performance and clinical utility of the syphilis reverse sequence algorithm (RSA) in a real-world setting.
• To assess the rate of reactive Treponema pallidum enzyme immunoassay (EIA) tests within the RSA.
• To investigate the adequacy of subsequent treatment documentation following positive EIA results in a veteran population.

Main Methods:

• Retrospective analysis of syphilis diagnostic data from a Veteran Affairs facility.
• Evaluation of the syphilis reverse sequence algorithm (RSA) workflow.
• Review of patient records for prior treatment status and documentation of post-diagnostic therapy.

Main Results:

• A 5.5% reactivity rate was observed for Treponema pallidum enzyme immunoassay (EIA) tests within the RSA.
• Among cases positive by EIA but negative by VDRL and positive by TP-PA (Treponema pallidum particle agglutination), 48% had a history of prior syphilis treatment.
• For veterans with unknown or no prior therapy, only 45% had documented evidence of subsequent treatment.

Conclusions:

• The syphilis reverse sequence algorithm (RSA) identified a notable proportion of reactive EIA tests.
• A significant percentage of EIA-positive veterans, particularly those with no prior treatment history, lacked documented follow-up care.
• Suboptimal interpretation or management of RSA results may be occurring, potentially impacting effective syphilis treatment and control in this population.