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Cited by 103Syphilis Diagnosis and TreatmentVector-borne infectious diseasesHistorical Medical Research and Treatments

Screening for syphilis with the treponemal immunoassay: analysis of discordant serology results and implications for clinical management.

Park, Ina U., Chow, Joan M., Bolan, Gail, Stanley, Mark, Shieh, Jennifer, Schapiro, Jeffrey M.·2011·The Journal of Infectious Diseases
DOI 10.1093/infdis/jir524
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Abstract

BACKGROUND: Screening for syphilis with treponemal chemiluminescence immunoassays (CIA) identifies patients with discordant serology who are not identified with traditional screening methods (eg, CIA-positive, rapid plasma regain (RPR)-negative). We sought to describe the clinical characteristics and management of patients with discordant syphilis serology. METHODS: From August 2007-October 2007, patients with CIA-positive, RPR-negative serology were tested with the Treponema pallidum particle agglutination assay (TP-PA) at Kaiser Permanente Northern California. Clinical and demographic characteristics, prior syphilis history and CIA index values were compared for CIA-positive, RPR-negative patients according to TP-PA status. RESULTS: Of 21,623 assays, 439 (2%) were CIA-positive and 255/439 (58%) were RPR-negative; subsequently, 184 (72%) were TP-PA-positive and 71 (28%) were TP-PA--negative. TP-PA--positive patients were more likely to be male, HIV-positive, homosexual, previously treated for syphilis (57% versus 9%), with higher median CIA index values (9.8 versus 1.6) (all P < .0001). After repeat testing, 7/31 (23%) CIA-positive, RPR-negative, TP-PA--negative patients seroreverted to CIA-negative. CONCLUSIONS: TP-PA results in conjunction with clinical/behavioral assessment helped guide the management of patients with CIA-positive, RPR-negative serology. TP-PA-positive patients were both highly likely to have prior syphilis and major epidemiologic risk factors for syphilis. CIA-positive, RPR-negative, TP-PA-negative serology may represent a false-positive CIA in low-prevalence populations.

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Crossref · 10.1093/infdis/jir524

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  • If the second treponemal test is negative, the positive EIA or CIA is more likely to represent a false-positive test result for women who are living in communities with low rates of syphilis, have a partner who is uninfected, and have no history of treated syphilis.

    “If the second treponemal test is negative (e.g., EIA positive, RPR negative, or TP-PA negative), the positive EIA or CIA is more likely to represent a false-positive test result for women who are living in communities with low rates of syphilis, have a partner who is uninfected, and have no history of treated syphilis (637,638).”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [637]

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Authors
Park, I. U., Chow, J. M., Bolan, G., Stanley, M., Shieh, J., & Schapiro, J. M.
Affiliations
  • California Department of Public Health (US)
  • Kaiser Permanente Northern California (US)
  • Kaiser Permanente (US)
ORCID
Venue
The Journal of Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2011-11-01
Volume
204
Issue
9
Pages
1297-1304
ISSN
  • 0022-1899 (ISSN-L)
  • 1537-6613
DOI
10.1093/infdis/jir524
OpenAlex
W2170864741
Cited by
103
References
26
Citations by year
2026: 4 · 2025: 5 · 2024: 2 · 2023: 4 · 2022: 7 · 2021: 4 · 2020: 5 · 2019: 2 · 2018: 10 · 2017: 9 · 2016: 10 · 2015: 13 · 2014: 9 · 2013: 6 · 2012: 8
FWCI
6.11
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Infectious Diseases (publishedVersion)
  • PubMed (publishedVersion)
Funders
Centers for Disease Control and Prevention (5h25ps904362-17)
Topics
  • Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
  • Life Sciences › Immunology and Microbiology › Parasitology › Vector-borne infectious diseases
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Historical Medical Research and Treatments
Keywords
syphilis screening, chemiluminescence immunoassay, Treponema pallidum particle agglutination assay, false-positive serology, seroreversion, syphilis management
MeSH terms
Adult, California, Female, Humans, Immunoassay, Male, Mass Screening, Middle Aged, Risk Factors, Sexual Behavior, Syphilis, Treponema pallidum

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