男男性行为人群外展环境下的快速梅毒检测：检测性能评估及其对治疗时间的影响。

Rapid Syphilis Testing for Men Who Have Sex With Men in Outreach Settings: Evaluation of Test Performance and Impact on Time to Treatment.

机构信息

Denver Public Health.

Colorado Department of Public Health and Environment, Division of Molecular Science and Public Health Microbiology, Denver, CO.

出版信息

Sex Transm Dis. 2019 Mar;46(3):191-195. doi: 10.1097/OLQ.0000000000000932.

DOI:10.1097/OLQ.0000000000000932

PMID:30363029

Abstract

BACKGROUND

Rapid syphilis tests (RST) may shorten time to syphilis diagnosis and treatment while enhancing access to testing in outreach settings. There are limited data on the performance of RST in outreach settings in the US.

METHODS

We offered RST (Syphilis Health Check) at 6 outreach sites to men who reported having sex with men and no prior history of syphilis. Clients accepting RST were also tested with laboratory-based rapid plasma reagin (RPR) and reflex Treponema pallidum particle agglutination (TPPA) assay when RPR or RST were positive. Clients with positive RST were immediately referred to a sexually transmitted infection clinic. Those declining RST were screened with RPR and reflex TPPA only. The validity of the RST-based algorithm was compared with the RPR-based algorithm among participants receiving both. Time to treatment for those accepting RST was compared with those declining RST and to a historical control group screened in outreach settings with RPR and reflex TPPA before the availability of RST.

RESULTS

Rapid syphilis test was accepted by 690 (64%) of 1081 eligible clients. Compared with RPR-based algorithm, RST sensitivity was 90%; specificity, 98.5%; positive predictive value, 47.4%; and negative predictive value, 98.5. The single false-negative case by RST was determined to be a late latent case by RPR/TPPA. Median time to treatment was 1 day (range, 0-6 days) for 9 of 690 accepting RST, compared to 9 days (range, 7-13 days) for 3 of 391 declining RST, and 9 days (range, 6-21 days) for 25 of 1229 historical controls (P < 0.0001).

CONCLUSION

Compared with an RPR-based algorithm, RST identified all early syphilis cases. Although RST had high specificity and negative predictive value, the low positive predictive value resulted in additional assessments in a sexually transmitted infection clinic for some patients. However, RST use in outreach settings significantly decreased time to treatment for new syphilis cases.

摘要

背景

快速梅毒检测（RST）可缩短梅毒诊断和治疗时间，并增加检测机会，尤其适用于外展环境。目前美国外展环境中 RST 的应用数据有限。

方法

我们在 6 个外展点为报告有男男性行为且无梅毒既往史的男性提供 RST（梅毒健康检查）。接受 RST 的患者，若 RPR 或 RST 阳性，则同时进行实验室快速血浆反应素（RPR）和梅毒螺旋体颗粒凝集（TPPA）检测。RST 阳性的患者立即转介至性传播感染门诊。拒绝 RST 的患者仅接受 RPR 和 TPPA 检测。比较接受 RST 和 RPR 检测的参与者中 RST 检测算法的有效性。比较接受 RST 的患者与拒绝 RST 的患者以及在 RST 可用之前接受 RPR 和 TPPA 外展筛查的历史对照组之间的治疗时间。

结果

690 名符合条件的 1081 名患者中有 690 名（64%）接受了快速梅毒检测。与 RPR 检测算法相比，RST 的敏感性为 90%，特异性为 98.5%，阳性预测值为 47.4%，阴性预测值为 98.5%。唯一一例 RST 假阴性病例通过 RPR/TPPA 被确认为潜伏晚期病例。接受 RST 的 9 名患者中，有 9 名（9 天，范围 0-6 天）在 1 天内接受了治疗，而 391 名拒绝 RST 的患者中，有 3 名（9 天，范围 7-13 天），1229 名历史对照组中有 25 名（9 天，范围 6-21 天）（P < 0.0001）。