Sex Transm Dis. 2018 Jan;45(1):35-38. doi: 10.1097/OLQ.0000000000000684.
Repeat syphilis is playing an increasing role in syphilis transmission in several populations. The assessment of repeat syphilis and response to treatment depends on accurately measuring intraindividual changes in non-treponemal tests. For a 0- to 6-month delta rapid plasma reagin (RPR) to be determined by routine individual RPR testing, samples are tested 6 months apart with differences in reagent batches, environmental conditions, and observers all leading to measurement errors. We hypothesized that conducting paired RPR testing (simultaneous testing of acute and convalescent samples) would enable a more accurate determination of delta RPR compared with individual testing.
A total of 120 study participants with a new diagnosis of syphilis were followed up at 0, 3, 6, 9, 12, 18, and 24 months, with RPR testing performed via individual testing at each study visit and at any suspected repeat syphilis. Rapid plasma reagin paired testing was performed on samples from 0 and 6 months and at any suspected repeat syphilis.
The quantitative agreement ±1 dilution among paired and individual testing was 97.2%. There was no difference in the proportion with serofast status at 6 months: 21 (19.4%) and 19 (17.6%) according to paired and individual testing, respectively (P = 0.726). There was no statistically significant difference between 0- and 6-month delta RPR as determined by paired and individual testing in predicting seroresponse at 12 months (86.1% and 91.6% agreement with 12-month serofast/nonserofast classification, respectively; P = 0.262).
In our setting, individual testing performed equally well compared with paired testing. Follow-up of syphilis will remain onerous for the patient and the health care provider until new tests that can more accurately assess the response to therapy and repeat syphilis/treatment failure are developed.
在一些人群中，重复梅毒在梅毒传播中扮演着越来越重要的角色。对重复梅毒的评估和治疗反应取决于准确测量非梅毒螺旋体试验中个体内的变化。为了通过常规个体 RPR 检测确定 0 至 6 个月的 delta 快速血浆反应素（RPR），样本需要在 6 个月时分开检测，期间试剂批次、环境条件和观察者的差异都会导致测量误差。我们假设进行配对 RPR 检测（同时检测急性和恢复期样本）将比个体检测更能准确确定 delta RPR。
共有 120 名新诊断为梅毒的研究参与者在 0、3、6、9、12、18 和 24 个月时进行随访，在每次研究访问时以及在任何疑似重复梅毒时通过个体检测进行 RPR 检测。在任何疑似重复梅毒时，对 0 和 6 个月的样本进行快速血浆反应素配对检测。
配对和个体检测之间的定量一致性为 97.2%。在 6 个月时血清固定状态的比例没有差异：分别根据配对和个体检测为 21（19.4%）和 19（17.6%）（P=0.726）。在预测 12 个月时血清学反应方面，0-6 个月 delta RPR 的配对和个体检测结果没有统计学差异（分别为 12 个月血清固定/非固定分类的 86.1%和 91.6%的一致性；P=0.262）。
在我们的环境中，个体检测与配对检测的效果相当。在开发出能够更准确评估治疗反应和重复梅毒/治疗失败的新检测方法之前，梅毒的随访对患者和医疗保健提供者来说仍然是一项繁重的任务。
