Rapid diagnostic testing to improve access to screening for syphilis in prison

Area of Science:

• Infectious Diseases
• Public Health
• Clinical Diagnostics

Background:

• Syphilis remains a significant public health concern, particularly in vulnerable populations such as incarcerated women.
• Accurate and accessible diagnostic tools are crucial for effective syphilis control and management in resource-limited settings.

Purpose of the Study:

• To evaluate the diagnostic accuracy of an on-site rapid treponemal test for syphilis in women deprived of liberty in Bolivia.
• To compare the performance of the rapid test with conventional serological methods (RPR, TPPA) and other treponemal tests (FTA).

Main Methods:

• A cross-sectional study was conducted with 219 women deprived of liberty at San Sebastián prison, Cochabamba, Bolivia.
• Syphilis diagnosis was confirmed using RPR and TPPA tests.
• The on-site rapid treponemal test (Alere DetermineTM Syphilis TP) using whole blood was compared against the gold standard.

Main Results:

• The rapid syphilis test achieved 100% sensitivity, correctly identifying all 28 participants who were positive for both RPR and TPPA.
• Out of 11 participants with a positive rapid test but discordant RPR/TPPA results, 7 had at least one of the conventional tests positive.
• The diagnostic performance of FTA tests varied, with 66.6% concordance between bioMérieux and Biocientífica reagents.

Conclusions:

• The Alere DetermineTM Syphilis TP rapid test exhibits excellent performance as a screening tool for syphilis in incarcerated women.
• This rapid test is highly recommended for settings with high syphilis prevalence and challenges in accessing conventional laboratory services due to its low cost, ease of use, and minimal infrastructure requirements.
• The FTA test using Biocientífica reagents showed suboptimal sensitivity, indicating potential limitations for its use.