Bureau of Public Health Laboratories, Florida Department of Health, Jacksonville, FL, USA.
Ann Lab Med. 2019 Jul;39(4):396-399. doi: 10.3343/alm.2019.39.4.396.
In Florida, where syphilis is a reportable disease, the number of primary and secondary (P&S) syphilis cases has increased from 3,266 in 2008-2010 to 5,340 in 2013-2015, a 63% increase. The objective of this study was to compare the performance and sensitivity of the syphilis reverse algorithm with the traditional algorithm for detecting P&S (infectious) syphilis cases. Clinical specimens from individuals who self-referred for syphilis testing at public health clinics were processed using the traditional algorithm (non-treponemal rapid plasma reagin (RPR) test followed by a confirmatory treponemal (EIA) test) and then further tested with the Architect Syphilis TP (ASTP) immunoassay (Abbott Diagnostics, Chicago, IL, USA) or by RPR confirmation, if needed (reverse algorithm). Of 1,079 specimens, 59 were positive for syphilis. The sensitivity of the reverse algorithm was 98.3% (58/59) and of the traditional algorithm was 72.9% (43/59). Based on clinical evidence, of the 16 traditional algorithm-negative but reverse algorithm-positive cases, 68.8% (11/16) were classified as missed P&S infections (treatment naïve) and 31.2% (5/16) were classified as missed past syphilis (latent or infections with documented linkage to care). The reverse algorithm enables the detection of additional P&S syphilis cases missed by our current traditional algorithm.
在佛罗里达州，梅毒是一种需报告的疾病，原发性和继发性（P&S）梅毒病例数量从 2008-2010 年的 3266 例增加到 2013-2015 年的 5340 例，增长了 63%。本研究的目的是比较梅毒反向算法与传统算法检测原发性和继发性（感染性）梅毒病例的性能和敏感性。从自行到公共卫生诊所进行梅毒检测的个体采集临床标本，采用传统算法（非梅毒螺旋体快速血浆反应素（RPR）试验，然后进行梅毒螺旋体（EIA）确认试验）进行处理，然后用 Architect Syphilis TP（ASTP）免疫测定法（雅培诊断，芝加哥，IL，美国）或根据需要进行 RPR 确认（反向算法）进一步检测。在 1079 份标本中，59 份梅毒阳性。反向算法的敏感性为 98.3%（58/59），传统算法的敏感性为 72.9%（43/59）。根据临床证据，在 16 例传统算法阴性但反向算法阳性的病例中，68.8%（11/16）被归类为原发性和继发性梅毒感染（未经治疗），31.2%（5/16）被归类为潜伏梅毒（或有记录的治疗关联性感染）。反向算法可检测到当前传统算法遗漏的额外原发性和继发性梅毒病例。
