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Comparing three treponemal tests for syphilis screening
Sean A Buono1, Hilary A Godwin2, Nicole M Green1
1Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA 90095; Los Angeles County Public Health Laboratories, Los Angeles County, Department of Public Health, Downey, CA 90242.
Insights
Three high-throughput treponemal immunoassays showed comparable performance for syphilis detection. The reverse algorithm identified more positive cases than the traditional method, improving syphilis screening.
Area of Science:
- Clinical diagnostics
- Immunology
- Microbiology
Background:
- Syphilis diagnosis relies on serological testing.
- High-throughput immunoassays are crucial for efficient screening.
- Evaluating new diagnostic platforms is essential for public health.
Purpose of the Study:
- To compare the performance and usability of three high-throughput treponemal immunoassays.
- To assess the effectiveness of reverse versus traditional syphilis testing algorithms.
- To evaluate the clinical utility of different syphilis screening methods.
Main Methods:
- Performance evaluation of Phoenix Biotech Trep-Sure, Siemens ADVIA Centaur, and DiaSorin LIAISON assays.
- Analysis of 1000 serum samples using these immunoassays.
- Comparison of results with Treponema pallidum particle agglutination (TP-PA) and traditional vs. reverse algorithms.
Main Results:
- All three immunoassays demonstrated high sensitivity, specificity, and agreement (98-100%) with TP-PA.
- Chemiluminescence platforms offered superior batching capabilities and reduced technologist time.
- The reverse algorithm identified 38 additional seropositive individuals compared to the traditional algorithm.
Conclusions:
- Treponemal immunoassays are reliable for syphilis screening and confirmation.
- Reverse algorithm approach enhances syphilis detection rates.
- Clinical evaluation aids in resolving discordant serological results.
Abstract:
We compared the performance and ease of use for three high-throughput treponemal immunoassays: Phoenix Biotech Trep-Sure Total Antibody EIA, Siemens ADVIA® Centaur Syphilis Assay, and DiaSorin LIAISON® Treponema Assay. One thousand serum samples submitted for routine screening were used in this study. Each assay demonstrated comparable sensitivity, specificity, and percent agreement (98-100%) compared with Treponema pallidum particle agglutination (TP-PA). Thus, treponemal immunoassays are an acceptable alternative for syphilis screening or confirmatory testing. Batch sizes and technologist active time varied between each treponemal immunoassay; the chemiluminescence platforms offered significantly greater ability to batch (random access vs. fixed batch sizes) in less time. When we compared the results obtained using a reverse algorithm approach to those obtained using a traditional algorithm, we found that the reverse algorithm identified 38 additional seropositive individuals that were not detected using the traditional algorithm. Clinical evaluation was useful for resolving cases with discordant serology.
