Amin A K, Manuel R J, Ison C A, Woodham R, Shemko M, Maguire H, Giraudon I, Forde J, Gillespie S H
Department of Medical Microbiology, Barts and The London NHS Trust, London, UK.
Sex Transm Infect. 2009 Apr;85(2):88-91. doi: 10.1136/sti.2008.033159. Epub 2008 Nov 12.
The number of cases of infectious syphilis is increasing rapidly across England and Wales. Concern has been expressed about diagnostic delay and its potential impact on patient care. A standard operating procedure for the serological diagnosis of syphilis has recently been developed by the Health Protection Agency. This study aimed to audit clinical and laboratory practice in England and Wales against this standard.
All microbiology departments, genitourinary medicine (GUM) clinics and antenatal clinics in England and Wales were invited to complete a web-based questionnaire.
The overall response rate was 76%. Practices varied between laboratories. The proportion of microbiology departments performing enzyme immunoassay (EIA), Treponema pallidum particle agglutination assay/T pallidum haemagglutination assay, rapid plasma reagin/Venereal Disease Reference Laboratory and EIA IgM were 94%, 34%, 41% and 10%, respectively. Of these, 57% only perform a single screening assay. The turnaround time for negative results was less than 1 week for 84% of microbiology departments. For positive samples, turnaround times varied from less than 1 week to 6-8 weeks, with 19% of GUM clinics reporting turnaround times of over 3 weeks. Notably, 26% of GUM clinics and 6% of antenatal clinics reported that delays in turnaround time had adversely affected patient management in the past year.
This study suggests that there is significant room to improve laboratory turnaround times for the diagnosis of syphilis in England and Wales, and such improvements would be a positive step in limiting the spread of infection and of congenital syphilis.
在英格兰和威尔士，感染性梅毒病例数正在迅速增加。人们对诊断延迟及其对患者护理的潜在影响表示担忧。健康保护局最近制定了梅毒血清学诊断的标准操作程序。本研究旨在对照该标准对英格兰和威尔士的临床及实验室实践进行审核。
邀请了英格兰和威尔士的所有微生物学部门、性传播疾病诊所和产前诊所完成一份基于网络的调查问卷。
总体回复率为76%。各实验室的做法存在差异。进行酶免疫测定（EIA）、梅毒螺旋体颗粒凝集试验/梅毒螺旋体血凝试验、快速血浆反应素试验/性病研究实验室试验以及EIA IgM的微生物学部门比例分别为94%、34%、41%和10%。其中，57%仅进行单一筛查试验。84%的微生物学部门阴性结果的周转时间少于1周。对于阳性样本，周转时间从少于1周到6 - 8周不等，19%的性传播疾病诊所报告周转时间超过3周。值得注意的是，26%的性传播疾病诊所和6%的产前诊所报告称，在过去一年中周转时间的延迟对患者管理产生了不利影响。
本研究表明，在英格兰和威尔士，梅毒诊断的实验室周转时间有显著的改进空间，而这种改进将是限制感染传播和先天性梅毒传播的积极一步。
