Positive Rapid Plasma Reagin Research Articles

A Complex Case of Extrahepatic Biliary Obstruction: Syphilitic abdominal lymphadenitis

Abstract Introduction/Objective Syphilis, a sexually transmitted disease that is caused by spirochete Treponema pallidum, can vary widely in presentation. Infective lymphadenitis due to syphilis have been reported before in cervical and inguinal lymph nodes.Here we present an interesting case of syphilitic lymphadenitis with unusual presentation and location. Methods/Case Report A 30-year-old male with no past medical history presented with epigastric pain, fever, jaundice, weight loss, and night sweats. Computed tomography imaging revealed a 4.1 cm solid mass at the porta hepatis with involvement of perihepatic lymph nodes, raising suspicion of malignancy. All serological tumor markers were negative. The patient underwent ERCP with biliary drainage to relieve obstructive jaundice. Bile duct brushing and liver biopsy at that time were non-diagnostic. Later the patient underwent laparoscopic lymph node excision. Histological examination of the lymph node showed intact follicular architecture with an increase in plasma cells and sinus histiocytes, without evidence of carcinoma or lymphoma cells. Flow cytometry on the lymph node showed polytypic B-cells and antigenically normal T-cells with CD4: CD8 ratio of 0.5 showing relatively excess of CD8 positive cytotoxic cells. Positive staining for Treponema pallidum with appropriate control highlighted micro-organisms suggestive of secondary syphilitic infection. This evidence was later supported by positive rapid plasma reagin (RPR) test. He subsequently tested positive for Human immunodeficiency virus (HIV-1). Results (if a Case Study enter NA) NA Conclusion In summary, appropriate histologic and serological testing lead to timely diagnosis in this case. This case contributes to the limited literature on syphilitic lymphadenitis and reports the first documented case of isolated intra- abdominal lymph node involvement.

Congenital Syphilis With Multiple Bone Fractures

We report a rare case of multiple fractures occurring in a 3-month-old boy with congenital syphilis (CS). His mother was diagnosed by a gynecologist with syphilis on a screening test before his birth. After birth, a serological panel revealed positive rapid plasma reagin and treponema pallidum hemagglutination assay test results. On the first visit, his left humerus was broken. Whole-body screening radiographs showed multiple fractures of both distal radii and the right first metatarsal. Immobilization was performed with a plastic splint, and callus formation of his humerus was seen after 3 weeks. CS cases have been increasing both in Japan and abroad in recent years. Orthopaedic surgeons should not forget the possibility of CS as a differential for fractures, especially in infants younger than 3 months born to syphilis-infected mothers.

Posterior Segment Manifestations of Syphilis and Correlation With Serologic Markers of Infection.

Retrospective analysis correlating serologic titers of ocular syphilis with posterior segment manifestations. This study consisted of 40 patients (80 eyes imaged, 68 affected) with positive rapid plasma reagin (RPR) and Treponema Pallidum immunoglobulin G. We collected demographic and presentation data including HIV status, absolute CD4 count, RPR, cerebrospinal fluid-venereal disease research laboratory (CSF-VDRL) test, and retinal zone. We categorized imaging into syphilitic outer retinopathy (SOR), acute syphilitic posterior placoid chorioretinopathy, retinitis/chorioretinitis (RC), and papillitis. Multivariate analysis correlated HIV status, RPR, and VDRL titers with posterior segment findings and zone. Mean age of 42.8 ± 10.7 years, with 70% male patients. Presenting visual acuity (logMAR) 0.66 ± 0.74 did not correlate with RPR, nor was it associated with papillitis, RC, or acute syphilitic posterior placoid chorioretinopathy. Higher RPR (≥ 1:128) positively associated with SOR (P = 0.031) and zone 1 (odds ratio [OR], 1.62; P = 0.02), but negatively associated with zone 2 (OR 0.35; P = 0.005). HIV positivity increased RC odds (OR, 4.45; P = 0.047). Higher RPR correlated with SOR and zone 1, whereas HIV positivity correlated with RC. [Ophthalmic Surg Lasers Imaging Retina 2024;55:511-516.].

Seroconversion in syphilis screening without positive confirmatory tests points at early infection

IntroductionThe chemiluminescence immunoassay (CLIA) is a widely used screening test for syphilis. A CLIA seroconversion in the absence of a positive line immunoassay (LIA) or rapid plasma reagin (RPR) could...

Chronic False Positive Rapid Plasma Reagin (RPR) Tests Induced by COVID-19 Vaccination

False positive reactive plasmin reagin (RPR) reactivity following a COVID-19 vaccine has been reported, and it is therefore conceivable that individuals who receive frequent coronavirus disease 2019 (COVID-19) vaccinations may exhibit durable RPR responses. Here, we sought to investigate the extent to which repeated mRNA COVID-19 vaccines can elicit chronic false RPR reactivity in a longitudinal cohort. Participants (n = 119) in an IRB-approved (#20201026), longitudinal SARS-CoV-2 cohort study were screened for RPR reactivity via manual RPR card assays. Samples with reactive results underwent additional testing, including follow-on RPR screening at additional timepoints, confirmatory fluorescent treponemal antibody (FTA-ABS) testing and anti-nuclear antibody (ANA) testing. Medical histories were collected. We observed (n = 2) screen-positive RPR results (1.7% [2/119]) following booster vaccination, for which two individuals exhibited chronic, vaccine-induced RPR reactivity for up to 9 months following booster vaccination. Both participants were ANA-negative. It is imperative for clinicians to be mindful of the potential immunologic interference of COVID-19 vaccines with standard infectious disease assays, including RPR testing. Detailed medical histories and clinical contexts, including recent vaccination, should be reviewed prior to proceeding with distressing and invasive workups.

Mooren’s Ulcer with Pathologic Findings Similar to Cicatricial Pemphigoid

Abstract To report a case of peripheral corneal thinning with a presentation similar to a Mooren’s ulcer but with pathology consistent with cicatricial pemphigoid. We report the case of a 56-year-old woman who presented with unilateral peripheral corneal thinning. Before presentation, the patient was treated with prednisone 60 mg daily, an amniotic membrane, and artificial tears. The patient denied any prior autoimmune history. The left cornea had nasal crescentic corneal thinning 6.0 mm tall and 1.5 mm wide. Visual acuity was 20/40 uncorrected in the involved eye. Initial laboratory workup was notable for a low positive rheumatoid factor and positive fluorescent treponemal antibody absorption but negative rapid plasma reagin. Corneal cultures were negative. The patient was started on oral and topical steroids, topical moxifloxacin, and mycophenolate mofetil and underwent a conjunctival resection. The conjunctival tissue was sent for pathology and was notable for strong deposits of immunoglobulin G at the epithelial basement membrane consistent with mucous membrane pemphigoid. Mycophenolate mofetil was discontinued due to oral thrush. Due to persistent activity, she underwent repeat conjunctival resection with the placement of an amniotic membrane over the area of thinning. She was subsequently started on rituximab biosimilar infusions and tapered off prednisone. Visual acuity at the last follow-up was 20/25. While conjunctival resection is a potential management option for Mooren’s ulcer, routine conjunctival biopsy for pathology is not. Our case highlights a potential overlap between the pathophysiology of ocular cicatricial pemphigoid and Mooren’s ulcer. Sending conjunctival tissue for pathology could provide benefits to the underlying mechanisms of different variants of Mooren’s ulcer.

Influence of Syphilis Infection on Abortions in Iraq

Introduction: Syphilis is a sexually transmitted disease, that may be transferred from mothers to infants during pregnancy if it is left untreated. Method: This study was conducted among 65 women who suffered from recurrent abortions in Iraq. Syphilis screening recombinant (IgM + IgG) level by ELISA, RADIM (Italy) and rapid plasma reagin (RPR) (positive and negative results) tests were used to analyse the data. Results: A non-significant association was observed with age (p=0.989), and the number of healthy births (p=0.643). Non-significant differences were observed in comparisons between smoker and non-smoker percentages in the study group. The rapid test for syphilis confirmation was applied using Rapid Plasma Reagin (RPR) tests. There was a significant elevation in syphilis level (IgG + IgM) in the positive test (p=0.027). The number of abortions and births had a non-significant correlation (p=0.318 and 0.783 respectively). There was a non-significant weak correlation between syphilis level (IgG + IgM) and age. Syphilis level had a non-significant association with the number of abortions, births, and with duration of marriage. The abortion percentage distribution showed a high percentage in the first trimester (75%) in positive RPR patients and 70.7% in negative results of RPR test. The second-trimester cases were low in the positive and negative RPR results than the first-trimester cases. Conclusion: The current study concluded that syphilis infection didn’t have a significant influence on abortion in women and had a non-significant influence on the number of abortions.

Retinitis after Long-Term Corticosteroid Use

A 61-year-old man presented with acute-onset blurriness in both eyes (OU). His medical history was significant for biopsy-negative temporal arteritis and long-term systemic corticosteroid use. On presentation, visual acuity was 20/40 with 3-4+ cells in the anterior chamber and 1+ cells in the vitreous OU. Fundus examination revealed elevated optic nerve margins and peripheral retinal whitening (Fig A). Laboratory work-up showed positive syphilis serology and elevated rapid plasma reagin 1:512. With the diagnosis of neurosyphilis the patient received intravenous penicillin, and vision improved to 20/20 with resolution of retinitis (Fig B).

S2017 Double Trouble: A Case of Co-Infection With Campylobacter and Giardia in a HIV-Positive Patient

Introduction: Patients with immunosuppressed states such as uncontrolled HIV are at increased risk for opportunistic infections including acute infectious diarrhea. Here, we present a case of a noncompliant HIV patient who presented with a complaint of acute diarrhea with resulting weight loss. Work-up was significant for co-infection with giardia and campylobacter as a result of receptive anal sexual intercourse. Case Description/Methods: A 45-year-old transgender male to female patient with a past medical history of poorly controlled HIV infection not actively on antiviral therapy and chronic Hepatitis B (HBV) infection presented with initial complaint of acute diarrhea for one week with accompanying weight loss. The patient concurrently complained of a diffuse, painful, pruritic rash for 5 days. A thorough history revealed the patient had just returned from Miami, where she reported multiple sexual partners with recent unprotected oral and anal intercourse. On initial presentation, the patient was tachycardic and febrile to 104.8, with generalized abdominal tenderness and a diffuse macular rash involving scalp, torso, genitals, and extremities, including palms and soles. The patient was admitted and started on acyclovir, vancomycin and ceftriaxone. A comprehensive stool panel was positive for both campylobacter and giardia. The patient was also noted to have CMV viremia, a HIV viral load of 38,000, and a positive rapid plasma reagin. The infectious disease team was consulted and the patient was treated with a single dose of tinidazole and 2 doses of metronidazole followed by a 7-day course of ciprofloxacin. Her acute diarrhea resolved, at which point she restarted antiretroviral therapy, and completed a 14-day course of penicillin for her syphilis. She was discharged home with close follow up with her infectious disease specialist. Discussion: This case highlights the increased risk of opportunistic infections in the setting of poorly controlled HIV and unprotected sexual intercourse as highlighted by this patient’s co-infection with both giardia and campylobacter. Campylobacter and giardia are 2 commonly associated foodborne illnesses, however they can be transmitted via unprotected oral-anal sex. In addition to compliance with HIV treatment, patients should consider barrier methods during receptive sex to prevent fecal-oral transmission. In sum, our case highlights the importance of keeping a broad differential of infectious causes of diarrhea, especially in the immunocompromised population.

Etiological Surveillance of Genital Ulcer Syndrome in South Africa: 2019 to 2020.

Herpes simplex virus (HSV) has been the leading cause of genital ulcer syndrome (GUS) in South Africa for more than a decade, and acyclovir therapy is incorporated into syndromic management guidelines. We conducted surveillance at 3 sentinel sites to define the common sexually transmitted etiologies of GUS and to determine whether current syndromic management is appropriate. Secondary objectives of surveillance were to determine the seroprevalence of coinfections (HIV, syphilis, HSV-2) in persons presenting with GUS. Consecutive, consenting adult men and women presenting with visible genital ulceration were enrolled between January 1, 2019, and December 31, 2020. Genital ulcer swab and blood specimens were collected and transported to a central sexually transmitted infection reference laboratory in Johannesburg. Among 190 participants with GUS, HSV-2 was the most frequently detected ulcer pathogen (49.0%; 95% confidence interval [CI], 41.9%-56.1%). The relative prevalence of the second most common ulcer-derived pathogen, Treponema pallidum, was 26.3% (95% CI, 20.5%-33.1%), with 90% of primary syphilis cases having a positive rapid plasma reagin (RPR) titer. Male sex was independently associated with primary syphilis compared with herpetic ulcers, after adjusting for the effect of casual sex partners and other exposures (adjusted odds ratio, 3.53; 95% CI, 1.35-9.21; P = 0.010). The overall HIV prevalence among participants was 41.3% (78 of 189; 95% CI, 34.2%-48.6%). Herpes simplex virus 2 remains the predominant cause of GUS, justifying the continued use of acyclovir in syndromic guidelines. Adequate supplies of benzathine penicillin G for syphilis treatment are essential at primary health care level, in addition to the provision of syphilis and HIV risk reduction services.

Acute Syphilitic Posterior Placoid Chorioretinitis With Subfoveal Choroidal Neovascularization Managed With Anti-VEGF Therapy.

We describe the development and management of choroidal neovascularization (CNV) in a patient with acute syphilitic posterior placoid chorioretinitis (ASPPC). A retrospective case review is presented. A 66-year-old man presented with unilateral blurry vision. He had a history of systemic syphilis infection twice, the last diagnosed 15 years before presentation and treated with intravenous ceftriaxone, resulting in seroreversion of an initially positive rapid plasma reagin (RPR). Examination revealed ASPPC with subfoveal CNV. Repeat testing revealed an RPR titer of 1:16 384. He was treated with 6 monthly intravitreal injections of bevacizumab and systemic antibiotics, resulting in resolution of his ASPPC and regression of his CNV. CNV is a rare complication of ASPPC. Multimodal imaging can be useful to suggest the diagnosis, and prompt treatment with systemic antibiotics and intravitreal anti-vascular endothelial growth factor agents can lead to resolution of ASPPC and regression of CNV, respectively.

The treatment outcome and predictors of serological response in syphilis in a sexually transmitted infections center, China.

Serology is the mainstay for syphilis treatment monitoring. Baseline rapid plasma reagin (RPR) titre, HIV status, and syphilis stage have been found to be associated with the time to serological response among syphilis patients. This study mainly aims to evaluate the time to serological response, and to identify factors affecting the serological outcome. Medical records of syphilis cases diagnosed in Peking Union Medical College Hospital (PUMCH) between 2008 and 2018 were retrospectively reviewed. Kaplan-Meier analysis was performed to evaluate the median time to serologic response and cumulative probability of serologic response over time according to different variables. Cox regression model was conducted to find factors associated with serological response. There were 984 patients diagnosed with primary, secondary, or latent syphilis cases and receiving injections of benzathine penicillin G (BPG) as initial treatment at the Peking Union Medical College Hospital (PUMCH) between 2008 and 2018. Finally, data on 571 patients, including 49 (8.6%) primary syphilis, 261 (45.7%) secondary syphilis, and 261 (45.7%) latent syphilis, were used for analysis. It took longer time to achieve serological response for subjects aged ≥45years than younger individuals (89days versus 58days; p=0.008). Males achieved serological response more quickly than females (71days versus 83days; p = 0.011). There was a significant difference in the time to serological response according to different syphilis stages (p < 0.001), with 55days (95% CI, 43-67days) for primary, 57days (95% CI, 51-63days) for secondary, and 117days for latent syphilis. In addition, patients with lower baseline RPR titre had longer period to achieve serological response (252days [95% CI, 129-375days] for RPR titre ≤1:8, 78days [95% CI, 63-93days] for RPR titres from 1:16 to 1:32, and 53days [95% CI, 49-57days] for RPR titres ≥1:64, respectively; p<0.001). However, no significant difference in time to serological response to treatment was found according to HIV coinfection status. The result of multivariate Cox regression analysis showed that being older than 45years with latent syphilis, HIV coinfection, or with baseline RPR titre ≤1:8 was associated with slow response. Among patients followed for at least 1year or seroreverted, 128 (36.9%) had seroreverted within a year, and 219 (63.1%) still had a positive RPR after 1year. For multiple logistical regression, being female and HIV coinfection were significantly associated with the failure of seroreversion (OR, 0.42 [95% CI, 0.26-0.68]; p <0.001). This study revealed that younger age, higher initial RPR titre, early syphilis stage, and HIV-negative status were associated with faster serological cure. Female sex, individuals with HIV coinfection, and latent syphilis were significantly associated with the failure of seroreversion.

Factors associated with syphilis seroprevalence in women with and at-risk for HIV infection in the Women’s Interagency HIV Study (1994–2015)

ObjectiveSyphilis rates among women in the USA more than doubled between 2014 and 2018. We sought to identify correlates of syphilis among women enrolled in the Women’s Interagency HIV Study...

Asymptomatic latent syphilis in geriatric patients in association with stoke: Analysis using routine syphilis tests

IntroductionWe investigated the association between stroke and asymptomatic latent syphilis (ALS) in geriatric patients. MethodsThis retrospective observational study included patients aged >65 years who underwent routine qualitative rapid plasma reagin (RPR) and Treponema pallidum Latex Agglutination (TPLA) tests at a 161-bed community acute care hospital with long-term care facilities in Kamakura, Japan, from August 2014 to February 2019. Asymptomatic patients with a positive TPLA test result were diagnosed with ALS. Ninety-six patients with ALS were included in the study. Fifty-one patients (53.1%) had a positive RPR test. Comorbidities included hypertension (n = 44; 45.8%), chronic kidney disease (n = 44; 45.8%), and fracture (n = 29; 30.2%). No significant differences were found in sex, age, or comorbidities in univariate analyses. Multivariate analysis of the TPLA-positive geriatric patients revealed that a positive RPR test (odds ratio = 9.06; 95% confidence interval = 1.69–48.5; p = 0.01) was associated with a history of stroke. ConclusionsFor geriatric patients with ALS, a positive qualitative RPR test was associated with a history of stroke. Medical evaluation and management of the risk factors for stroke are more necessary for ALS with a positive RPR qualitative test.

Severe Congenital Syphilis in the Neonatal Intensive Care Unit: A Retrospective Case Series.

There has been a 291% relative increase in congenital syphilis (CS) cases in the United States from 2015 to 2019. Although the majority of affected fetuses/infants are stillborn or are asymptomatic, a subset is born with severe clinical illness. We describe a series of severe CS cases in the neonatal intensive care unit. Retrospective review of infants with CS, admitted to the Duke Intensive Care Nursery from June 2016 to February 2020. We recorded birthweight, gestational age, medications, procedures, diagnoses, laboratory data and outcomes. Severe symptoms included: birth depression, hypoxic ischemic encephalopathy (HIE), disseminated intravascular coagulopathy and/or persistent pulmonary hypertension (PPHN). Seven infants with CS were identified and 5 with severe presentations were included. Median gestational age was 35.1 weeks (range: 29-37 weeks, median: 35 weeks). All infants required intubation at birth, 2 required chest compressions and epinephrine in the delivery room. One had hydrops fetalis and died in the delivery room. All 4 surviving infants had HIE, severe PPHN, hepatitis and seizures. All infants had a positive rapid plasma reagin, and were treated with penicillin G. Maternal rapid plasma reagin was pending for 3 of 5 infants at delivery, and later returned positive; 2 were positive during pregnancy but not treated. Other infectious work-up was negative. Three infants survived to discharge. CS can be associated with HIE, PPHN and disseminated intravascular coagulopathy in affected infants. Clinicians should have a high index of suspicion and include CS in their differential diagnoses. This study also highlights the importance of adequate treatment of identified cases and screening during the third trimester and at delivery.

ED syphilis and gonorrhea/chlamydia cotesting practices before and after the implementation of an electronic health record-based alert

BackgroundThe prevalence of syphilis is increasing in many countries, including the USA. The ED is often used by underserved populations, making it an important setting to test and treat patients...

High Number of Positive Rapid Plasma Reagin With Low Titers Using the Automated AIX 1000 RPR System.

This study evaluated the performance of manual rapid plasma reagin (RPR) and automated AIX1000 RPR tests for the diagnosis of syphilis. Manual RPR showed a 3% reactive result compared with 5.8% for the automated test mainly because of RPR reactive results with low titers not confirmed by Treponema pallidum particle agglutination.

Etiologies of genital inflammation and ulceration in symptomatic Rwandan men and women responding to radio promotions of free screening and treatment services.

IntroductionThe longstanding inadequacies of syndromic management for genital ulceration and inflammation are well-described. The Rwanda National Guidelines for sexually transmitted infection (STI) syndromic management are not yet informed by the local prevalence and correlates of STI etiologies, a component World Health Organization guidelines stress as critical to optimize locally relevant algorithms.MethodsRadio announcements and pharmacists recruited symptomatic patients to seek free STI services in Kigali. Clients who sought services were asked to refer sexual partners and symptomatic friends. Demographic, behavioral risk factor, medical history, and symptom data were collected. Genital exams were performed by trained research nurses and physicians. We conducted phlebotomy for rapid HIV and rapid plasma reagin (RPR) serologies and vaginal pool swab for microscopy of wet preparation to diagnose Trichomonas vaginalis (TV), bacterial vaginosis (BV), and vaginal Candida albicans (VCA). GeneXpert testing for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) were conducted. Here we assess factors associated with diagnosis of NG and CT in men and women. We also explore factors associated with TV, BV and VCA in women. Finally, we describe genital ulcer and RPR results by HIV status, gender, and circumcision in men.ResultsAmong 974 men (with 1013 visits), 20% were positive for CT and 74% were positive for NG. Among 569 women (with 579 visits), 17% were positive for CT and 27% were positive for NG. In multivariate analyses, factors associated with CT in men included younger age, responding to radio advertisements, <17 days since suspected exposure, and not having dysuria. Factors associated with NG in men included not having higher education or full-time employment, <17 days since suspected exposure, not reporting a genital ulcer, and having urethral discharge on physical exam. Factors associated with CT in women included younger age and < = 10 days with symptoms. Factors associated with NG in women included younger age, lower education and lack of full-time employment, sometimes using condoms vs. never, using hormonal vs. non-hormonal contraception, not having genital ulcer or itching, having symptoms < = 10 days, HIV+ status, having BV, endocervical discharge noted on speculum exam, and negative vaginal wet mount for VCA. In multivariate analyses, only reporting >1 partner was associated with BV; being single and RPR+ was associated with TV; and having < = 1 partner in the last month, being pregnant, genital itching, discharge, and being HIV and RPR negative were associated with VCA. Genital ulcers and positive RPR were associated with being HIV+ and lack of circumcision among men. HIV+ women were more likely to be RPR+. In HIV+ men and women, ulcers were more likely to be herpetic rather than syphilitic compared with their HIV- counterparts.ConclusionsSyndromic management guidelines in Rwanda can be improved with consideration of the prevalence of confirmed infections from this study of symptomatic men and women representative of those who would seek care at government health centers. Inclusion of demographic and risk factor measures shown to be predictive of STI and non-STI dysbioses may also increase diagnostic accuracy.

Clinical presentation of congenital syphilis in a rotavirus vaccine cohort study in Lusaka: a case series

BackgroundDespite an otherwise robust national antenatal clinic program, maternal and congenital syphilis remains an important public health issue in Zambia. This case series reports the clinical presentation of seven infants diagnosed with congenital syphilis in Lusaka, Zambia.Case presentationsThe cases in this series were incidental findings from a cohort of infants enrolled in a rotavirus vaccine immunogenicity study recruiting infants at 6 weeks of age. As part of clinical care for enrolled participants, we screened mothers of children who presented with adverse events of (i) repeated upper respiratory tract infections/coryza, (ii) skin lesions, and (iii) poor weight gain, for syphilis using rapid plasma reagin test. From a cohort of 214 mother–infant pairs enrolled between September and December 2018, a total of 115 (44.4%) of the mothers reported to have not been screened during antenatal care. Of these, four (3.5%) reported to have tested positive; and only two received treatment. Seven out of 57 (26.6%) children meeting the screening criteria had a positive rapid plasma reagin test result. The mean age at diagnosis was 4.5 months (1.3 months standard deviation), and the common presenting features included coryza (6/7), skin lesions (4/7), conjunctivitis (3/7), pallor/anemia (5/7), wasting (2/7), and underweight (5/7). Three of the seven infants were exposed to human immunodeficiency virus. Following diagnosis, all seven cases received standard treatment according to national treatment guidelines. That is, 6/7 cases received inpatient care with benzylpenicillin for 10 days, while 1/7 was treated as an outpatient and received daily procaine penicillin for 10 days.ConclusionThese findings suggest that, though screening for syphilis is part of the standard antenatal care in Zambia, it is not offered optimally. There is urgent need to address programmatic shortcomings in syphilis screening and treatment to avoid long-term sequelae. Additionally, clinicians need to raise their index of suspicion and rule out syphilis when confronted with these clinical symptoms, regardless of the mother’s human immunodeficiency virus status.

Biological false positive rapid plasma reagin tests in pregnant females in North India

Background: Syphilis, a sexually transmitted disease seriously complicate pregnancy and produce harmful results in fetus. Screening of pregnant females in early pregnancy with non-treponemal tests such as RPR and VDRL is a cost effective strategy for diagnosis of syphilis. However, these tests could produce BFP reaction in pregnancy. The prevalence of which may be different in different populations and at different times. The current prevalence of the biological false positive rapid plasma regain tests in pregnant females of North India was there for assessed and being reported.Methods: A total 500 consecutive pregnant females who presented to our tertiary care center for the first time were screened for syphilis by RPR (a non-treponemal test) and Hi-Quik (a treponemal test) after obtaining their written consent.Results: Of the 500 females 21 (4.2%) were RPR positive and only one (0.2%) was Hi-Quik positive. Thus the prevalence of biological false positive rapid plasma regain tests in pregnant females of North India was 4% (20/500). In semi quantitative RPR, these tests were positive in ≤1:4 dilution and were not found to be related to any particular age, geographical distribution, literacy status, occupation or period of gestation (p value &gt;0.05) and were transient in nature.Conclusions: Our study concludes that although RPR is a good, cost effective test for mass screening of pregnant females, but it produces BFP reactions in considerable percentage (4%) in pregnant females of North India.