Accelerating worldwide syphilis screening through rapid testing: a systematic review.

Syphilis is a persistent public health issue in many low-income countries that have limited capacity for testing, which traditionally relies on a sensitive non-treponemal test and then a specific treponemal test. However, the development of a new rapid treponemal test provides an opportunity to scale up syphilis screening in many settings where traditional tests are unavailable. This systematic review of immunochromatographic strip (ICS) syphilis tests describes the sensitivity and specificity in two important clinical settings: sexually transmitted infection (STI) clinics and antenatal clinics. Clinical data from more than 22 000 whole blood, plasma, or fingerstick ICS tests obtained at STI or antenatal clinics were retrieved from 15 studies. ICS syphilis tests have a high sensitivity (median 0.86, interquartile range 0.75-0.94) and a higher specificity (0.99, 0.98-0.99), both comparable with non-treponemal screening test characteristics. Further research evaluating ICS syphilis tests among primary syphilis cases and among patients infected with HIV will be essential for the effective roll-out of syphilis screening programmes.

[1]  C. Conde-González,et al.  [Maternal and congenital syphilis in two Mexican hospitals: evaluation of a rapid diagnostic test]. , 2006, Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion.

[2]  A. Pollard,et al.  Syphilis in pregnancy and the neonatal period , 2006, International journal of STD & AIDS.

[3]  Rosanna W. Peeling,et al.  Evaluation of rapid diagnostic tests: syphilis , 2006, Nature Reviews Microbiology.

[4]  R. Peeling,et al.  Avoiding HIV and dying of syphilis , 2004, The Lancet.

[5]  R. Peeling,et al.  A multi-centre evaluation of nine rapid, point-of-care syphilis tests using archived sera , 2006, Sexually Transmitted Infections.

[6]  D. Grossman,et al.  Diagnostic accuracy of a point-of-care syphilis test when used among pregnant women in Bolivia , 2006, Sexually Transmitted Infections.

[7]  R. Peeling,et al.  Prospective, multi-centre clinic-based evaluation of four rapid diagnostic tests for syphilis , 2006, Sexually Transmitted Infections.

[8]  A. Corwin,et al.  Evaluation of rapid diagnostic tests for the detection of human immunodeficiency virus types 1 and 2, hepatitis B surface antigen, and syphilis in Ho Chi Minh City, Vietnam. , 2000, The American journal of tropical medicine and hygiene.

[9]  T. Quinn,et al.  Association of biologic false-positive reactions for syphilis with human immunodeficiency virus infection. , 1992, The Journal of infectious diseases.

[10]  K. Radcliffe.  Developing evidence-based guidelines for the management of sexually transmitted diseases in former Soviet Union countries. , 2005, International Journal of STD and AIDS.

[11]  N. Low,et al.  Global control of sexually transmitted infections , 2006, The Lancet.

[12]  John M Colford,et al.  Diagnostic accuracy of nucleic acid amplification tests for tuberculous meningitis: a systematic review and meta-analysis. , 2003, The Lancet. Infectious diseases.

[13]  P. Selwyn,et al.  Effects of HIV Infection on the Serologic Manifestations and Response to Treatment of Syphilis in Intravenous Drug Users , 1993, Annals of Internal Medicine.

[14]  D. Grossman,et al.  Demonstrating Public Health at Work: A Demonstration Project of Congenital Syphilis Prevention Efforts in Bolivia , 2007, Sexually transmitted diseases.

[15]  Ying-Hua Yu,et al.  Diagnostic value of vacuum-assisted breast biopsy for breast carcinoma: a meta-analysis and systematic review , 2010, Breast Cancer Research and Treatment.

[16]  J. Pfeiffer,et al.  Scaling Up Antenatal Syphilis Screening in Mozambique: Transforming Policy to Action , 2007, Sexually transmitted diseases.

[17]  T. Wong,et al.  What's new in management of sexually transmitted infections? Canadian Guidelines on Sexually Transmitted Infections, 2006 Edition. , 2007, Canadian family physician Medecin de famille canadien.

[18]  L. Juárez-Figueroa,et al.  [Evaluation of a rapid diagnostic test to assess the prevalence of maternal syphilis in Bolivia]. , 2009, Revista medica de Chile.

[19]  R. Peeling,et al.  Field evaluation of the performance and testing costs of a rapid point-of-care test for syphilis in a red-light district of Manaus, Brazil , 2008, Sexually Transmitted Infections.

[20]  Felipe Uribe-Salas,et al.  Sífilis materna y congénita en dos hospitales mexicanos: evaluación de una prueba diagnóstica rápida , 2006 .

[21]  R. Peeling,et al.  Rapid tests for sexually transmitted infections (STIs): the way forward , 2006, Sexually Transmitted Infections.

[22]  Jonathan J Deeks,et al.  Systematic reviews in health care: Systematic reviews of evaluations of diagnostic and screening tests. , 2001, BMJ.

[23]  M. A. Lantz,et al.  FTA-ABS and VDRL slide test reactivity in a population of nuns. , 1971, JAMA.

[24]  Mazeda Hossain,et al.  The Elimination of Congenital Syphilis: A Comparison of the Proposed World Health Organization Action Plan for the Elimination of Congenital Syphilis With Existing National Maternal and Congenital Syphilis Policies , 2007, Sexually transmitted diseases.

[25]  Huanzhong Shi,et al.  Diagnostic Value of Interferon-γ in Tuberculous Pleurisy: A Metaanalysis , 2007 .

[26]  A. Zwinderman,et al.  Meta-analyses of diagnostic studies , 2009, Clinical chemistry and laboratory medicine.

[27]  S. Fann,et al.  A blood-result turn-around time survey to improve congenital syphilis prevention in a rural area. , 1996, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[28]  R. Peeling,et al.  The pathogenesis of syphilis: the Great Mimicker, revisited , 2006, The Journal of pathology.

[29]  M. Gianino,et al.  Performance and costs of a rapid syphilis test in an urban population at high risk for sexually transmitted infections. , 2007, Journal of preventive medicine and hygiene.

[30]  S. Larsen,et al.  Laboratory diagnosis and interpretation of tests for syphilis , 1995, Clinical microbiology reviews.

[31]  B. Azadian,et al.  Is increased surveillance for asymptomatic syphilis in an HIV outpatient department worthwhile? , 2003, Sexually transmitted infections.

[32]  Tracy A Wolff,et al.  USPSTF recommendations for STI screening. , 2008, American family physician.

[33]  L. Morison,et al.  Performance of the rapid plasma reagin and the rapid syphilis screening tests in the diagnosis of syphilis in field conditions in rural Africa , 2002, Sexually transmitted infections.

[34]  C. Levin,et al.  Analysis of the Operational Costs of Using Rapid Syphilis Tests for the Detection of Maternal Syphilis in Bolivia and Mozambique , 2007, Sexually transmitted diseases.

[35]  P. Brentlinger,et al.  Comparison of the diagnostic accuracy of a rapid immunochromatographic test and the rapid plasma reagin test for antenatal syphilis screening in Mozambique. , 2006, Bulletin of the World Health Organization.

[36]  G. Schmid,et al.  Onsite Rapid Antenatal Syphilis Screening With an Immunochromatographic Strip Improves Case Detection and Treatment in Rural South African Clinics , 2007, Sexually transmitted diseases.

[37]  M. Mrcp,et al.  UK National Guidelines on the Management of Syphilis 2008 , 2008, International journal of STD & AIDS.

[38]  S. Rahman,et al.  Field Evaluation of Simple Rapid Tests in the Diagnosis of Syphilis , 2008, International journal of STD & AIDS.

[39]  J. Klausner,et al.  Syphilis and HIV infection: an update. , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[40]  K. Holmes,et al.  Utility of the Determine Syphilis TP rapid test in commercial sex venues in Peru , 2006, Sexually Transmitted Infections.

[41]  M. Siedner,et al.  Performance of Rapid Syphilis Tests in Venous and Fingerstick Whole Blood Specimens , 2004, Sexually transmitted diseases.