+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

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



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



Journal of Infectious Diseases 204(9): 1297-1304



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. 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. 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. 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.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 055672644

Download citation: RISBibTeXText

PMID: 21930610

DOI: 10.1093/infdis/jir524


Related references

Screening for antibodies against Treponema pallidum with chemiluminescent microparticle immunoassay: analysis of discordant serology results and clinical characterization. Annals of Clinical Biochemistry 53(Pt 5): 588-592, 2016

Screening for syphilis with dual algorithms: analysis of discordant and concordant serology results in a population with a low prevalence of syphilis. Journal of the European Academy of Dermatology and Venereology 33(1): 178-184, 2019

Clinical comparison of the treponema palladium Captiao Syphilis-G enzyme immunoassay with the fluorescent treponemal antibody-absorption IGG assay for syphilis screening. Transfusion 37(9 Suppl. ): 57S, 1997

Use of the INNO-LIA syphilis score assay in the resolution of discordant positive screening enzyme immunoassay results for the serological diagnosis of syphilis. International Journal of Std and Aids 25(1): 52-56, 2014

Markers of past syphilis in HIV infection comparing Captia Syphilis G anti-treponemal IgG enzyme immunoassay with other treponemal antigen tests. International Journal of Std and Aids 6(2): 101-104, 1995

Clinical comparison of the Treponema pallidum CAPTIA syphilis-G enzyme immunoassay with the fluorescent treponemal antibody absorption immunoglobulin G assay for syphilis testing. Journal of Clinical Microbiology 37(10): 3233-3234, 1999

False-positive reactions in the rapid plasma reagin-card, fluorescent treponemal antibody-absorbed, and hemagglutination treponemal syphilis serology tests. Journal of Clinical Microbiology 9(3): 369-372, 1979

False-negative syphilis treponemal enzyme immunoassay results in an HIV-infected case-patient. International Journal of Std and Aids 28(7): 735-737, 2017

Syphilis serology in patients with primary syphilis and non-treponemal sexually transmitted diseases in southern Africa. Genitourinary Medicine 67(2): 129-132, 1991

Discordant Syphilis Immunoassays in Pregnancy: Perinatal Outcomes and Implications for Clinical Management. Clinical Infectious Diseases 61(7): 1049-1053, 2015

Syphilis diagnosis: screening by enzyme immunoassay and variation in fluorescent treponemal antibody absorbed (FTA-ABS) confirmatory test performance. Medical Laboratory Sciences 49(1): 50-55, 1992

The laboratory impact of changing syphilis screening from the rapid-plasma reagin to a treponemal enzyme immunoassay: a case-study from the Greater Toronto Area. Sexually Transmitted Diseases 38(3): 190-196, 2011

The Captia syphilis M enzyme immunoassay for treponemal immunoglobulin M in syphilis infection and treatment monitoring. Abstracts of the General Meeting of the American Society for Microbiology 93: 509, 1993

A comparison of the analytical level of agreement of nine treponemal assays for syphilis and possible implications for screening algorithms. Bmj Open 3(9): E003347, 2013

Immuno fluorescence by incident light in syphilis serology fluorescent treponemal antigen and 5 i and fluorescent treponemal antigen absorption test i reactions. Quaderni Sclavo de Diagnostica Clinica e di Laboratorio 12(1): 1-9, 1976