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Reverse Sequence Syphilis Screening and Discordant Results in Pregnancy
Jessica E P Williams1, José A Bazan2, Abigail Norris Turner3
1Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
The Journal of Pediatrics
|February 26, 2020
Summary
A widely used syphilis screening algorithm may produce false-positive results in pregnant women. Most discordant screening results in pregnant individuals showed a nonreactive confirmatory test, suggesting a false-positive treponemal multiplex flow immunoassay.
Area of Science:
- Medical Diagnostics
- Infectious Disease Research
- Reproductive Health
Background:
- The "reverse sequence syphilis screening" algorithm is a common method for syphilis detection.
- Discordant results between initial screening and confirmatory tests can occur, necessitating further investigation.
Purpose of the Study:
- To evaluate the significance of discordant syphilis screening results in pregnant women.
- To determine the frequency of false-positive reactions in a specific screening algorithm.
Main Methods:
- Retrospective analysis of syphilis testing data.
- Review of results from treponemal multiplex flow immunoassay (MFI) and rapid plasma reagin (RPR) tests.
- Analysis of confirmatory Treponema pallidum-particle agglutination (TP-PA) assay results.
Main Results:
- Most pregnant women (65%) with discordant screening results (MFI IgG+/RPR-) had a nonreactive TP-PA assay.
- This suggests a high rate of false-positive MFI results in this population.
- The findings highlight potential overdiagnosis of syphilis in pregnant women using this algorithm.
Conclusions:
- The "reverse sequence syphilis screening" algorithm may lead to a significant number of false-positive syphilis diagnoses in pregnant women.
- Confirmation testing is crucial for accurate syphilis diagnosis, especially in pregnant populations.
- Further research may be needed to optimize syphilis screening protocols for pregnant women.
