Screening for syphilis

Abstract

Sir—Willi Kurt Roth and colleagues’ (Jan 30, p 359) study of PCR to screen for hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV seem promising in reducing the transmission of these infections through blood and blood products that have screened negative for these infections with conventional antigen-antibody testing. However, the possibility that infected blood could be obtained from a donor who tested negative for these infections during the window period has serious implications for those in the blood transfusion services and recipients alike. The nucleic acid amplification tests described by the investigators to reduce this risk to a minimum is a step in the right direction. I was, however, dismayed by the investigators’ naive suggestion that screening donated blood for syphilis should be abolished to reduce the cost of introducing these expensive tests. They are probably unaware of the prevailing prevalence of syphilis in many European countries. In the newly independent states of the former Soviet Union the incidence of syphilis has risen rapidly. N o t i f i c a t i o n for syphilis in the Russian Federation in 1996 was 263 per 100 000 total population—a 48-fold increase over 1989. With the opening of the borders and free travel to and from these countries, the worry that the incidence of syphilis could escalate from its current levels of below 10 per 100 0 0 0 population in Western Europe is real. In the UK, congenitally transmitted syphilis still occurs. More importantly, a 26% increase in the incidence of infectious syphilis was reported for 1997 following an outbreak in Bristol. Trabzon, a trade city in the Black Sea region of Turkey, saw an outbreak of syphilis in the 1990s, that was believed to be imported through tourism and c o m m e r c e . WHO has also responded to this crisis in Eastern Europe and in collaboration with the Joint United Nations Programme on HIV/AIDS has set up an international task force that will mobilise and coordinate a multiagency response to halt the spread of syphilis and other sexually transmitted infections. Roth and colleagues should therefore think before they act on their own advice and take the retrograde step of stopping screening of syphilis in donated blood. In fact, if the syphilis epidemic spreads in Europe, the blood transfusion services may have to deal with the possibility of collecting infected blood that may be seronegative for syphilis. PCR testing for HBV, HCV, and HIV should be introduced on its own merit. Good medicine in the new millennium will come at a price.