Syphilis screening in the Blood Transfusion Service: a report of four years' experience with the Treponema pallidum haemagglutination assay and the subsequent development of a rapid "spin" method.

A comparison of cardiolipin and a modified Treponema pallidum haemagglutination assay (TPHA) method over a four year period confirmed the superior sensitivity and specificity of TPHA. In 86,495 new donor sera 19 (0.02%) confirmed positive results were detected by TPHA, 10 of which did not react by the cardiolipin test. In 150,789 antenatal samples 49 confirmed positive results were found by TPHA, 30 of which did not react by cardiolipin. No cardiolipin positive, TPHA negative samples were confirmed as positive by the absorbed fluorescence treponemal antibody test, and overall 78% of cardiolipin reactions gave false biological positive results. Cardiolipin tests were continued only because of their speed. A further modification ("spin") of the TPHA has now been developed which is rapid, sensitive, and inexpensive, and in testing 21,807 sera, gave results equivalent to those of the previous "settle" method. Serious consideration should be given to dispensing with cardiolipin tests.