Rapid Syphilis Tests Research Articles

Perceptions, attitude and uptake of rapid syphilis testing services in antenatal clinics in North-Western Tanzania.

Infection with syphilis during pregnancy could cause spontaneous abortion, low birth weight and stillbirth. To prevent adverse pregnancy outcomes caused by syphilis, the World Health Organization (WHO) recommends syphilis screening and treatment of all pregnant women attending antenatal care (ANC) services. Rapid syphilis testing (RST) demonstration project was introduced at ANC clinics in Tanzania in 2009, to assess the feasibility, acceptability and its impact on uptake of syphilis screening service. Data collection was composed of in-depth interviews with health workers and pregnant women attending ANC. Additionally, from the health facility registers we extracted information on the uptake of antenatal care services, including number of pregnant women screened and treated for syphilis. Introduction of RST at health facilities was appreciated by pregnant women attending ANC and health workers. Following the introduction of RST services at ANC clinics, we observed a significant increase of the uptake of syphilis screening. Pregnant women appreciated RST service since it reduced the frequency of their visits to the health facilities and shortened the duration that they spent at the clinics. Moreover, the provision of same-day screening and treatment services helped women to save money that they would have to spend on transportation for the follow up visits. Health workers felt that RST simplified procedures to diagnose syphilis, and enabled the health workers to test and treat large numbers of clients in a shorter period of time. Our study demonstrates that, it is feasible to introduce RST service in antenatal clinics. The RST was appreciated by health workers and pregnant women, since it simplifies syphilis screening procedures, saves the time that pregnant women used to waste to wait for the results, and saves the cost that women would have to spend on transportation to come back for treatment.

Field evaluation of a dual rapid diagnostic test for HIV infection and syphilis in Lima, Peru

ObjectivesScreening for HIV and syphilis in key populations is recommended by the WHO to reduce the morbidity, mortality and transmission associated with undiagnosed and untreated infections. Rapid point-of-care tests that...

P07.28 Syphilis testing in antenatal care: policies and practices among laboratories in the americas

Introduction The World Health Organization (WHO) recommends universal syphilis testing in pregnancy as part of basic maternal and child health services. Coupled with HIV testing, antenatal syphilis testing is fundamental for the regional initiative on elimination of mother-to-child transmission of HIV and congenital syphilis (EMTCT) in the Americas and globally. We conducted this survey of laboratory practices around syphilis testing to characterise syphilis testing in the Pan American Health Organisation (PAHO) member countries. Methods A structured survey assessing syphilis laboratory testing practices in the 35 PAHO member states was administered electronically between March and August 2014. Leaders of national reference labs, large regional laboratories and a sample of local (e.g., large maternal hospitals, district hospitals) and private laboratories that conducted syphilis testing were recruited to participate. The survey collected data on laboratories tests used, testing algorithms applied in different clinical settings, testing volume and turnaround time, quality assurance strategies, and results reporting to national surveillance. Results Data were obtained from 30 (86%) PAHO member states, including 36 national or regional reference laboratories and 33 lower level laboratories, primarily (94%) publicly funded. Of 69 laboratories reporting results, 41% used rapid syphilis tests (RSTs), of which 36% were lower level laboratories. Sixty-eight percent of reporting laboratories (83% of national/regional) participated in external quality control, and 36% reported surveillance data. Of the 69 laboratories, 49 (71%) reported using a national algorithm for syphilis testing in pregnancy, of which 5 involved RSTs. Of 54 (78%) laboratories that reported processing samples from antenatal clinics, approximately half experienced stock outs of at least one essential commodity during the previous 12 months. Conclusions Updating laboratory algorithms along with improving testing standards and quality assurance, supply distribution, and surveillance reporting could better advance EMTCT of syphilis and improve syphilis testing in various clinical settings in the Americas Region. Disclosure of interest No grants or outside funding were received in the development of this study.

S04.2 New diagnostics for syphilis and yaws and detection ofhaemophilus ducreyiin cutaneous lesions in children

Introduction We evaluated a multiplex PCR assay that can distinguish between syphilis and yaws on children with cutaneous lesions. Also, a rapid syphilis test, Chembio DPP Screen and Confirm Assay was evaluated for serological diagnosis of yaws. Methods Lesions swabs for PCR were obtained from children (5–14 years old) in West Akyem Municipality, Ghana pre- and post-MDA with azithromycin and pre-MDA on Tanna Island, Vanuatu. DPP testing was done on site and blood was collected for serology (RPR and TPPA). Molecular diagnosis and screening for azithromycin resistance markers was done using TaqMan-based real-time multiplex PCR tests. Another duplex PCR test was used to detect H. ducreyi and M. ulcerans. Results Pre-MDA TPPA and RPR dual positivity was 35.8% (63/176) in Vanuatu and 33.6% (109/326) in Ghana and post-MDA was 18.6% (16/43) and 6.5% (3/46), respectively in children with skin lesions. The overall sensitivity and specificity of the DPP treponemal component versus TPPA was 88.2% and 82.7%, and DPP non-treponemal component versus RPR was 84.8% and 94.7%. In children with T. pertenue PCR-positive lesions, dual positive DPP had an overall sensitivity and specificity of 86.3% and 78.6%, and a PPV of 44% and a NPV of 96.7%. 14.9% (27/181) of pre-MDA swab samples from Vanuatu and 17.3% (31/179) in Ghana were PCR-positive for T. pertenue . None of the 49 samples from Ghana were positive for T. pertenue post-MDA. Azithromycin resistance markers were not found in any of the samples. H. ducreyi was detected by PCR in 40.3% (73/181) of samples from Vanuatu, and 27.4% (51/208) from Ghana pre-MDA and 28.6% (14/49) in Ghana post-MDA. Six children were co-infected with T. pertenue and H. ducreyi in Vanuatu and seven in Ghana. M. ulcerans was not detected. Conclusion The DPP test is a useful screening test to exclude yaws in cases with a high index of suspicion on clinical grounds and the real-time PCR is essential for confirmation of a yaws diagnosis. MDA with oral azithromycin is effective for treatment of yaws but has limited impact on H. ducreyi .

P07.19 Added value of a novel dual treponemal/nontreponemal rapid diagnostic test for syphilis among pregnant women

Introduction In resource-limited settings, syphilis rapid diagnostic tests (RDTs) aide in the prevention of congenital syphilis. However, most syphilis RDTs detect only treponemal antibodies which persist after treatment. Consequently, treatment may be provided unnecessarily to pregnant women with past infection. We estimated the potential reduction of over-treatment by comparing a new RDT detecting both treponemal and non-treponemal antibodies, with a treponemal RDT (T-RDT). Methods A prospective descriptive study among pregnant women in antenatal care was conducted in Deou, Burkina Faso. The women were included if they were eligible for routine syphilis screening and provided informed consent. DPP Screen and Confirm assay (Chembio) and T-RDT (SD Bioline) were performed on whole blood specimens by a trained laboratory technician. Plasma was tested in an international reference laboratory by T. Pallidum Particle Agglutination (TPPA) and quantitative Rapid Plasma Reagin, (RPR). Presumptive active syphilis was defined as both TPPA and RPR were reactive. Results A total of 242 pregnant women were included: 91 (37.6%) had a presumptive active syphilis and one-in-five (19.8%) had high RPR titres ≥1:8. The DPP did not reduce the number of incorrectly treated cases (over-treatment) compared to the T-RDT (0.0% vs. 2.5%; p = 0.218). In addition, the DPP led to a higher proportion of under-treatment compared to the T-RDT (18.2% vs. 0.8%; p Conclusion This study was the first evaluation of DPP in pregnant women. DPP showed no added value in reducing the proportion of women unnecessarily treated. Conversely, it underestimated women needing treatment. Our study population may not have been representative as the surprising high seroprevalence may suggest presence of other treponemal infections in the area. Accordingly, additional studies are required to evaluate the potential benefits of DPP. Disclosure of interest statement Medecins Sans Frontieres funded this study. Epicentre receives core funding from Medecins Sans Frontieres. No pharmaceutical grants were received in the development of this study. The authors have declared that no competing interests exist.

P12.07 Delivering increased service provision: ippf experience of providing targeted technical support within existing srh service delivery points for strengthened sti-specific service provision

Introduction In 2013, the International Planned Parenthood Federation (IPPF) set out a strategy for increasing service provision across the IPPF Member Associations (MAs). A key service area identified for rapid scale-up was sexually transmitted infections (STIs). As a global service provider of sexual and reproductive health (SRH), the prevention and management of STIs has long been an integral part of IPPF’s mission. However, the provision of services for STIs, other than HIV, has been a lower priority among many IPPF MAs in recent years. Methods To support the strengthening of STI-specific services, small seed grants were provided to eight MAs covering all six of IPPF’s geographical regions to conduct a rapid assessment of existing service delivery points. This action-oriented process enabled MAs to set their own goals and directions, and to prioritise interventions to address STIs through existing service delivery points. Specific assessments determined the current service capacity and identified technical assistance needs for increasing STI-specific service delivery. Results The assessments of existing service delivery points gathered information on key issues affecting access, utilisation, and quality of care services for STIs, and identified staff training needs. Overall analysis led to the identification of specific deficiencies affecting service delivery and need for improving programme-level interventions including training and updating guidelines for STIs. Some key opportunities included the scaling-up of both syndromic management and etiological diagnosis in all service delivery points, strengthened integration with other SRH-related services, rollout of rapid diagnostic syphilis testing, and prioritising interventions for young people including vaccination, prevention and screening. Conclusion With commitment and support, targeted technical assistance with limited resources enabled the development of strategic recommendations for scaling-up effective STI-specific services. A number of existing simple, effective, and cost-effective services were identified for implementation towards increasing quality STI services at existing service delivery points providing SRH services. Disclosure of interest statement Nothing to declare.

P09.37 Syphilis rapid test validation for treponemal diagnosis in guatemala, 2013–2014

Background International guidelines for syphilis testing recommend non-treponemal tests, and confirmation by more complex treponemal test such as Treponema pallidum haemagglutination (TPHA), enzyme-linked immunosorbent assay (ELISA) or others. Similar to HIV rapid tests, rapid treponemal tests can improve point-of-care testing in laboratories with limited capacities. We present main results of a validation for treponemal diagnosis performed in Guatemala. Methods A syphilis rapid test laboratory validation was performed in two phases during 2013–2014. First stage was performed using frozen serums from National Health Laboratory and second stage was performed using whole blood from pregnant women from peripheral health services from Guatemala City. Four treponemal rapid tests were evaluated in the first stage: Determine TP (DetTP), SD Syphilis (SDSyp), Omega Visitect (OVis), and Rapid Syphilis (RSyp). Only two tests were evaluated in the second stage: DetTP and SDSyp. For confirmation, TPHA was used for diagnosis of treponemal antibodies in serum and treponemal ELISA for plasma. Results A total of 460 serums were evaluated in first stage and 432 whole blood samples in second stage. Compared to TPHA, sensitivity ranged from 87.8% for RSyp to 99.2% in DetTP in serum and 100% for SDSyp and DetTP in whole blood. Specificity was lower, ranging from 74.8% for DetTP to 87.7% for SDSyp in serum and 100% for SDSyp and DetTP in whole blood. Conclusion Rapid treponemal tests are a useful diagnostic tool in syphilis. Sensibility was high enough to be used as a screening test, with good results in whole blood samples. Low prevalence of syphilis in the validation contributed to poor positive predictive values. The use of a reverse algorithm might be useful for implementation of this test in Guatemala. Disclosure of interest statement We declare that we have no conflicts of interest.

P09.36 Improving uptake, interpretation and quality of syphilis testing in the americas through the development of a new regional guidance document

Introduction In 2009, an initiative to eliminate mother-to-child transmission (MTCT) of HIV and congenital syphilis was launched in the Americas. The region sought to develop means of increasing uptake of syphilis testing for pregnant women and key populations at risk for syphilis to ensure prompt detection and treatment with minimal loss to follow-up. Methods For a regional consultation, a PAHO/CDC team reviewed the published and grey literature on syphilis testing to identify regional standards and gaps. In April 2014, a regional meeting was held with representatives from health ministries and technical experts in maternal and child health and laboratory diagnostics. Participants reviewed and discussed the data, reported on best practices, and identified key areas to be included in a regional policy document. Results Participants raised several concerns, such as a lack of regional or global guidance on syphilis testing strategies for specific clinical settings being a barrier impeding elimination of MTCT of HIV and syphilis. Also, limited integration of HIV and syphilis program and operations’ systems was a “missed opportunity” to leverage efficiencies, personnel and funding in many countries. Furthermore, existing “best practices” promoting syphilis testing in different clinical settings had not been widely circulated. Participants recommended the development of a regional consensus document. In March 2015, this Guidance outlining syphilis testing algorithms in different clinical settings was published emphasising 5 areas for national programs: (1) comprehensive national policies on syphilis testing and treatment; (2) syphilis testing algorithms appropriate for specific populations or clinical (or outreach) settings, depending on laboratory capacity (e.g., rapid syphilis testing strategies); (3) ongoing quality assurance of syphilis testing; (4) procurement mechanisms supporting high-quality and affordable syphilis test kits and supplies; and (5) enhanced national reporting of syphilis cases. Conclusion This first-ever Regional Guidance on syphilis testing will set standards on which future country assessments will be evaluated.

Diagnostic accuracy of rapid tests for sexually transmitted infections in symptomatic women

ObjectiveTo determine the diagnostic accuracy of tests developed for use at the point of care for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and syphilis in women having symptoms of lower...

Introduction of Syphilis Point-of-Care Tests, from Pilot Study to National Programme Implementation in Zambia: A Qualitative Study of Healthcare Workers' Perspectives on Testing, Training and Quality Assurance.

Syphilis affects 1.4 million pregnant women globally each year. Maternal syphilis causes congenital syphilis in over half of affected pregnancies, leading to early foetal loss, pregnancy complications, stillbirth and neonatal death. Syphilis is under-diagnosed in pregnant women. Point-of-care rapid syphilis tests (RST) allow for same-day treatment and address logistical barriers to testing encountered with standard Rapid Plasma Reagin testing. Recent literature emphasises successful introduction of new health technologies requires healthcare worker (HCW) acceptance, effective training, quality monitoring and robust health systems. Following a successful pilot, the Zambian Ministry of Health (MoH) adopted RST into policy, integrating them into prevention of mother-to-child transmission of HIV clinics in four underserved Zambian districts. We compare HCW experiences, including challenges encountered in scaling up from a highly supported NGO-led pilot to a large-scale MoH-led national programme. Questionnaires were administered through structured interviews of 16 HCWs in two pilot districts and 24 HCWs in two different rollout districts. Supplementary data were gathered via stakeholder interviews, clinic registers and supervisory visits. Using a conceptual framework adapted from health technology literature, we explored RST acceptance and usability. Quantitative data were analysed using descriptive statistics. Key themes in qualitative data were explored using template analysis. Overall, HCWs accepted RST as learnable, suitable, effective tools to improve antenatal services, which were usable in diverse clinical settings. Changes in training, supervision and quality monitoring models between pilot and rollout may have influenced rollout HCW acceptance and compromised testing quality. While quality monitoring was integrated into national policy and training, implementation was limited during rollout despite financial support and mentorship. We illustrate that new health technology pilot research can rapidly translate into policy change and scale-up. However, training, supervision and quality assurance models should be reviewed and strengthened as rollout of the Zambian RST programme continues.

The Lisbon Cohort of men who have sex with men

PurposeNewly diagnosed HIV infections among men who have sex with men (MSM) are rising in many European countries. Surveillance tools must be tailored to the current state of the epidemic,...

Assessment of the impact of rapid syphilis tests on syphilis screening and treatment of pregnant women in Zambia

ObjectiveTo evaluate the impact of rapid syphilis tests (RSTs) on syphilis testing and treatment in pregnant women in Kalomo District, Zambia. MethodsIn March 2012, health workers at all 35 health facilities in Kalomo Distract were trained in RST use and penicillin treatment. In March 2013, data were retrospectively abstracted from 18 randomly selected health facilities and stratified into three time intervals: baseline (6months prior to RST introduction), midline (0–6 months after RST introduction), and endline (7–12 months after RST introduction). ResultsData collected on 4154 pregnant women showed a syphilis-reactive seroprevalence of 2.7%. The proportion of women screened improved from baseline (140/1365, 10.6%) to midline (976/1446, 67.5%), finally decreasing at endline (752/1337, 56.3%) (P<0.001). There was no significant difference in the proportion of syphilis-seroreactive pregnant women who received 1 dose of penicillin before (1/2, 50%) or after (5/48, 10.4%; P=0.199) RST introduction with low treatment rates throughout. ConclusionWith RST scale-up in Zambia and other resource-limited settings, same-day test and treatment with penicillin should be prioritized to achieve the goal of eliminating congenital syphilis.

Introduction of rapid syphilis testing in antenatal care: A systematic review of the impact on HIV and syphilis testing uptake and coverage

BackgroundGlobal guidelines recommend universal syphilis and HIV screening for pregnant women. Rapid syphilis testing (RST) may contribute toward achievement of universal screening. ObjectivesTo examine the impact of RST on syphilis and HIV screening among pregnant women. Search strategyWe searched MEDLINE for English- and non-English language articles published through November, 2014. Selection criteriaWe included studies that used a comparative design and reported on syphilis and HIV test uptake among pregnant women in low- and middle-income countries (LMICs) following introduction of RST. Data collection and analysisData were extracted from six eligible articles presenting findings from Asia, Africa, and Latin America. Main resultsAll studies reported substantial increases in antenatal syphilis testing following introduction of RST; the latter did not appear to adversely impact antenatal HIV screening levels at sites already offering rapid HIV testing and may increase HIV screening among pregnant women in some settings. Qualitative data revealed that women were highly satisfied with RST. Nevertheless, ensuring adequate training for healthcare workers and supplies of commodities were cited as key implementation barriers. ConclusionsRST may increase antenatal syphilis and HIV screening and contribute to the improvement of antenatal care in LMICs.

Laboratory evaluation of three dual rapid diagnostic tests for HIV and syphilis in China and Nigeria

ObjectiveTo determine the laboratory-based performance and operational characteristics of three dual rapid diagnostic tests (RDTs) for testing HIV and syphilis. MethodsThree dual RDTs (SD Bioline, Chembio, and MedMira) were evaluated using 1514 serum specimens archived at laboratories or collected from clinics in China and Nigeria to determine sensitivity and specificity, with 95% confidence intervals. Concordance of testing results read by two technicians, stability of testing results read at two time points, and test operation characteristics were also assessed. ResultsAll three of the evaluated RDTs gave excellent performance with a combined sensitivity ranging from 99.0%–99.6% for HIV and 98.3%–99.0% for syphilis, and a combined specificity ranging from 97.9%–99.0% for HIV and 97.2%–99.6% for syphilis. Concordance of testing results between two technicians and stability of testing results read within and one hour past the recommended reading period showed excellent agreement, with Kappa greater than or equal to 0.98. ConclusionsAll the tests were found to be very or fairly easy to use and easy to interpret the results. Further evaluations of these dual RDTs with whole blood in field settings, and more studies on the implication of introduction of these tests in HIV and syphilis control programs are needed.

Syphilis testing in antenatal care: Policies and practices among laboratories in the Americas

ObjectiveTo asses laboratory syphilis testing policies and practices among laboratories in the Americas. MethodsLaboratory directors or designees from PAHO member countries were invited to participate in a structured, electronically-delivered survey between March and August, 2014. Data on syphilis tests, algorithms, and quality control (QC) practices were analyzed, focusing on laboratories receiving specimens from antenatal clinics (ANCs). ResultsSurveys were completed by 69 laboratories representing 30 (86%) countries. Participating laboratories included 36 (52%) national or regional reference labs and 33 (48%) lower-level laboratories. Most (94%) were public sector facilities and 71% reported existence of a national algorithm for syphilis testing in pregnancy, usually involving both treponemal and non-treponemal testing (72%). Less than half (41%) used rapid syphilis tests (RSTs); and only seven laboratories representing five countries reported RSTs were included in the national algorithm for pregnant women. Most (83%) laboratories serving ANCs reported using some type of QC system; 68% of laboratories reported participation in external QC. Only 36% of laboratories reported data to national/local surveillance. Half of all laboratories serving ANC settings reported a stockout of one or more essential supplies during the previous year (median duration, 30days). ConclusionUpdating laboratory algorithms, improving testing standards, integrating data into existing surveillance, and improved procurement and distribution of commodities may be needed to ensure elimination of MTCT of syphilis in the Americas.

Sero-conversion rate of Syphilis and HIV among pregnant women attending antenatal clinic in Tanzania: a need for re-screening at delivery.

BackgroundDespite the available cost effective antenatal testing and treatment, syphilis and human immunodeficiency virus (HIV) are still among common infections affecting pregnant women especially in developing countries. In Tanzania, pregnant women are tested only once for syphilis and HIV during antenatal clinic (ANC) visits. Therefore, there are missed opportunities for syphilis and HIV screening among those who were not tested during ANC visits and those acquiring infections during the course of pregnancy. This study was designed to determine the syphilis and HIV seroprevalence at delivery and seroconversion rate among pregnant women delivering at Bugando Medical Centre (BMC).MethodsA cross sectional, hospital-based study involving pregnant women attending Bugando Medical Centre (BMC) antenatal clinic was done from January to March 2012. Serum samples were collected and tested for HIV and syphilis using HIV and syphilis rapid tests. Demographic and clinical data were collected using a standardized data collection tool and analysed using STATA version 11.ResultsA total of 331 and 408 women were screened for syphilis and HIV during antenatal respectively. Of 331 women who screened negative for syphilis at ANC, nine (2.7%) were seropositive at delivery while of 391who tested negative for HIV during ANC eight (2%) were found to be positive at delivery. Six (1.8%) and 23 (9%) of women who did not screen for syphilis and HIV at ANC were seropositive for syphilis and HIV at delivery respectively. There was significant difference of seroprevalence for HIV, among women who tested negative at ANC and those who did not test at ANC (2% vs.9%, P,<0.001). The overall prevalence of syphilis and HIV at delivery was 15 (2.3%) and 48 (7.2%) respectively. Syphilis seropositivity at delivery was significantly associated with HIV co-infection (p < 0.001), male partner circumcision (p = 0.011) and alcohol use among women (p < 0.001).ConclusionsThe current protocol of screening for syphilis and HIV only once during pregnancy as practiced in Tanzania may miss women who get re-infected and seroconvert during pregnancy. Re-screening for syphilis and HIV during the course of pregnancy and at delivery is recommended in Tanzania as it can help to identify such women and institute appropriate treatment.

Prevalence and correlates of HIV among men who have sex with men in Tijuana, Mexico.

IntroductionMen who have sex with men (MSM) in developing countries such as Mexico have received relatively little research attention. In Tijuana, Mexico, a border city experiencing a dynamic HIV epidemic, data on MSM are over a decade old. Our aims were to estimate the prevalence and examine correlates of HIV infection among MSM in this city.MethodsWe conducted a cross-sectional study of 191 MSM recruited through respondent-driven sampling (RDS) in 2012. Biological males over the age of 18 who resided in Tijuana and reported sex with a male in the past year were included. Participants underwent interviewer-administered surveys and rapid tests for HIV and syphilis with confirmation.ResultsA total of 33 MSM tested positive for HIV, yielding an RDS-adjusted estimated 20% prevalence. Of those who tested positive, 89% were previously unaware of their HIV status. An estimated 36% (95% CI: 26.4–46.5) had been tested for HIV in the past year, and 30% (95% CI: 19.0–40.0) were estimated to have ever used methamphetamine. Independent correlates of being infected with HIV were methamphetamine use (odds ratio [OR]=2.24, p=0.045, 95% CI: 1.02, 4.92) and active syphilis infection (OR=4.33, p=0.01, 95% CI: 1.42, 13.19).ConclusionsOur data indicate that MSM are a key sub-population in Tijuana at higher risk for HIV. Tijuana would also appear to have the highest proportion among upper-middle-income countries of HIV-positive MSM who are unknowingly infected. More HIV prevention research on MSM is urgently needed in Tijuana.

Finding a needle in the haystack: the costs and cost-effectiveness of syphilis diagnosis and treatment during pregnancy to prevent congenital syphilis in Kalomo District of Zambia.

BackgroundIn March 2012, The Elizabeth Glaser Pediatric AIDS Foundation trained maternal and child health workers in Southern Province of Zambia to use a new rapid syphilis test (RST) during routine antenatal care. A recent study by Bonawitz et al. (2014) evaluated the impact of this roll out in Kalomo District. This paper estimates the costs and cost-effectiveness from the provider's perspective under the actual conditions observed during the first year of the RST roll out.MethodsInformation on materials used and costs were extracted from program records. A decision-analytic model was used to evaluate the costs (2012 USD) and cost-effectiveness. Basic parameters needed for the model were based on the results from the evaluation study.ResultsDuring the evaluation study, 62% of patients received a RST, and 2.8% of patients tested were positive (and 10.4% of these were treated). Even with very high RST sensitivity and specificity (98%), true prevalence of active syphilis would be substantially less (estimated at <0.7%). For 1,000 new ANC patients, costs of screening and treatment were estimated at $2,136, and the cost per avoided disability-adjusted-life year lost (DALY) was estimated at $628. Costs change little if all positives are treated (because prevalence is low and treatment costs are small), but the cost-per-DALY avoided falls to just $66. With full adherence to guidelines, costs increase to $3,174 per 1,000 patients and the cost-per-DALY avoided falls to $60.ConclusionsScreening for syphilis is only useful for reducing adverse birth outcomes if patients testing positive are actually treated. Even with very low prevalence of syphilis (a needle in the haystack), cost effectiveness improves dramatically if those found positive are treated; additional treatment costs little but DALYs avoided are substantial. Without treatment, the needle is essentially found and thrown back into the haystack.

Laboratory evaluation of a dual rapid immunodiagnostic test for HIV and syphilis infection.

New dual tests for HIV and syphilis have been developed. Our study aimed to evaluate the laboratory performance of a dual rapid immunodiagnostic test for HIV and syphilis. Our evaluation showed high performance of this dual rapid test, which should be considered for implementation to increase screening coverage and efficiency.

Prevalence of syphilis and associated factors in homeless people of Sao Paulo, Brazil, using a Rapid Test.

Homeless people are a vulnerable group to sexually transmitted diseases (STD) with high prevalence of syphilis and hepatitis. To estimate the prevalence of syphilis infection and its association with risky behaviors for STDs in a sample of homeless people, and to assess the feasibility of the use of rapid syphilis test (RST) in this population. Cross-sectional study, in a convenience sample of homeless people assisted in social support services of São Paulo, between 2006 and 2007. A structured questionnaire was applied and RST was performed. In addition, a blood sample for syphilis detection was also collected. The sensitivity and specificity of the RST was estimated using conventional laboratory diagnosis (VDRL + TPHA) as reference. 1,405 volunteers were included in the study. The prevalence rate of syphilis was 7.0%, and was associated with homosexual practices (OR(adj) 4.9; 95%CI 2.6 - 9.4), prior history of STD (OR(adj) 2.6; 95%CI 1.7 - 4.0) and with self-referred non-white race (OR(adj) 1.9; 95%CI 1.1 - 3.4). The sensitivity and specificity of the RST for syphilis were, respectively, 81.4 and 92.1%. The high prevalence of syphilis infection among homeless people shows the need for actions for its control and the utilization of RST that can be considered an efficient strategy due to its sensitivity and specificity. Public Health policymakers must strengthen actions for syphilis control, with screening tests for syphilis and early treatment, decreasing morbidity with the improvement of sexual and reproductive health of the population in general and especially the most vulnerable.