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Evaluating congenital syphilis in a reverse sequence testing environment

May W Chen1, Ibukunoluwa C Akinboyo2,3, Paul K Sue2,4

  • 1Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.

Journal of Perinatology : Official Journal of the California Perinatal Association
|May 12, 2019
PubMed

Insights

Maternal reverse-sequence (RS) syphilis screening did not improve infant management for congenital syphilis (CS). In a high-risk group, RS testing did not identify additional CS cases, with discordant results often relying on clinical judgment.

Area of Science:

  • Infectious Diseases
  • Maternal-Fetal Medicine
  • Clinical Diagnostics

Background:

  • Congenital syphilis (CS) poses significant risks to newborns.
  • Accurate maternal syphilis screening is crucial for preventing CS.
  • Reverse-sequence (RS) testing is a diagnostic approach for syphilis.

Purpose of the Study:

  • To evaluate the impact of maternal RS syphilis screening on the management of infants at risk for CS.
  • To assess if RS testing aids in identifying additional CS cases in a high-risk population.

Main Methods:

  • Retrospective study (2011-2014) at an academic medical center.
  • Utilized RS testing including chemiluminescent immunoassay (CIA), rapid plasma reagin (RPR), and fluorescent treponemal antibody-absorption (FTA-ABS).
  • Compared clinical management and outcomes of infants born to mothers with discordant serology (CIA+/RPR-/FTA+) against guidelines.

Main Results:

  • Sixty-three infants were analyzed: 21 discordant, 16 presumed false positive, and 26 true positive.
  • Only 24% of infants in the discordant group received the recommended full evaluation.
  • No infants in the evaluated discordant group (n=8) were diagnosed with CS.

Conclusions:

  • Management of infants with discordant maternal RS serology often depends on clinical judgment.
  • RS testing in this high-risk population did not lead to the identification of additional CS cases.
  • Standardized approaches to CS prevention and infant management require further investigation.
Abstract

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