Rhoads Daniel D, Genzen Jonathan R, Bashleben Christine P, Faix James D, Ansari M Qasim
From the Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio (Drs Rhoads and Ansari); the Department of Pathology, University of Utah, Salt Lake City (Dr Genzen); the Department of Surveys, College of American Pathologists, Northfield, Illinois (Ms Bashleben); and the Department of Pathology, Montefiore Medical Center, Bronx, New York (Dr Faix).
Arch Pathol Lab Med. 2017 Jan;141(1):93-97. doi: 10.5858/2016-0110-CP. Epub 2016 Oct 20.
-Syphilis serology screening in laboratory practice is evolving. Traditionally, the syphilis screening algorithm begins with a nontreponemal immunoassay, which is manually performed by a laboratory technologist. In contrast, the reverse algorithm begins with a treponemal immunoassay, which can be automated. The Centers for Disease Control and Prevention has recognized both approaches, but little is known about the current state of laboratory practice, which could impact test utilization and interpretation.
-To assess the current state of laboratory practice for syphilis serologic screening.
-In August 2015, a voluntary questionnaire was sent to the 2360 laboratories that subscribe to the College of American Pathologists syphilis serology proficiency survey.
-Of the laboratories surveyed, 98% (2316 of 2360) returned the questionnaire, and about 83% (1911 of 2316) responded to at least some questions. Twenty-eight percent (378 of 1364) reported revision of their syphilis screening algorithm within the past 2 years, and 9% (170 of 1905) of laboratories anticipated changing their screening algorithm in the coming year. Sixty-three percent (1205 of 1911) reported using the traditional algorithm, 16% (304 of 1911) reported using the reverse algorithm, and 2.5% (47 of 1911) reported using both algorithms, whereas 9% (169 of 1911) reported not performing a reflex confirmation test. Of those performing the reverse algorithm, 74% (282 of 380) implemented a new testing platform when introducing the new algorithm.
-The majority of laboratories still perform the traditional algorithm, but a significant minority have implemented the reverse-screening algorithm. Although the nontreponemal immunologic response typically wanes after cure and becomes undetectable, treponemal immunoassays typically remain positive for life, and it is important for laboratorians and clinicians to consider these assay differences when implementing, using, and interpreting serologic syphilis screening algorithms.
实验室实践中的梅毒血清学筛查正在不断发展。传统上，梅毒筛查算法始于非梅毒螺旋体免疫测定，由实验室技术人员手动操作。相比之下，反向算法始于梅毒螺旋体免疫测定，该测定可以自动化。疾病控制与预防中心认可了这两种方法，但对于可能影响检测利用和解读的实验室实践现状知之甚少。
评估梅毒血清学筛查的实验室实践现状。
2015年8月，向订阅美国病理学家学会梅毒血清学能力验证调查的2360家实验室发送了一份自愿调查问卷。
在接受调查的实验室中，98%（2360家中的2316家）返回了问卷，约83%（2316家中的1911家）至少回答了一些问题。28%（1364家中的378家）报告在过去2年内修订了梅毒筛查算法，9%（1905家中的170家）实验室预计在来年改变其筛查算法。63%（1911家中的1205家）报告使用传统算法，16%（1911家中的304家）报告使用反向算法，2.5%（1911家中的47家）报告同时使用两种算法，而9%（1911家中的169家）报告未进行反射性确认试验。在采用反向算法的实验室中，74%（380家中的282家）在引入新算法时采用了新的检测平台。
大多数实验室仍采用传统算法，但少数实验室已实施反向筛查算法。尽管非梅毒螺旋体免疫反应通常在治愈后减弱并变得无法检测，但梅毒螺旋体免疫测定通常终生保持阳性，对于实验室工作人员和临床医生而言，在实施、使用和解读梅毒血清学筛查算法时考虑这些检测差异非常重要。
