Discordant Syphilis Immunoassays in Pregnancy: Perinatal Outcomes and Implications for Clinical Management

The reverse sequence algorithm is often used for prenatal syphilis screening by high-volume laboratories, beginning with a treponemal test such as the chemiluminescence immunoassay (CIA), followed by testing of CIA-positive (CIA(+)) specimens with the rapid plasma reagin test (RPR). The clinical sig...

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Vydáno v:	Clinical infectious diseases Ročník 61; číslo 7; s. 1049
Hlavní autoři:	Mmeje, Okeoma, Chow, Joan M, Davidson, Lisette, Shieh, Jennifer, Schapiro, Jeffrey M, Park, Ina U
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States 01.10.2015
Témata:	Adult Female Humans Immunoassay - methods Immunoassay - standards Pregnancy Pregnancy Complications, Infectious - diagnosis Pregnancy Complications, Infectious - immunology Pregnancy Complications, Infectious - therapy Pregnancy Outcome - epidemiology Retrospective Studies Syphilis - diagnosis Syphilis - immunology Syphilis - therapy Syphilis Serodiagnosis - methods Syphilis Serodiagnosis - standards discordant treponemal serology prenatal syphilis treatment prenatal syphilis screening treponemal immunoassay congenital syphilis
ISSN:	1537-6591, 1537-6591
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Shrnutí:	The reverse sequence algorithm is often used for prenatal syphilis screening by high-volume laboratories, beginning with a treponemal test such as the chemiluminescence immunoassay (CIA), followed by testing of CIA-positive (CIA(+)) specimens with the rapid plasma reagin test (RPR). The clinical significance of discordant serology (CIA(+)/RPR(-)) for maternal and neonatal outcomes is unknown. From August 2007 to August 2010, all pregnant women at Kaiser Permanente Northern California with discordant treponemal serology underwent reflexive testing with Treponema pallidum particle agglutination assay (TP-PA) and were categorized as "TP-PA confirmed" (CIA(+)/RPR(-)/TP-PA(+)) or "isolated CIA positive" (CIA(+)/RPR(-)/TP-PA(-)). Demographic variables and clinical data were abstracted from the medical record and compared by TP-PA status. Of 194 pregnant women, 156 (80%) were CIA(+)/RPR(-)/TP-PA(-) and 38 (20%) were CIA(+)/RPR(-)/TP-PA(+). Among the 77 (49%) CIA(+)/RPR(-)/TP-PA(-) women who were retested, 53% became CIA(-). CIA(+)/RPR(-)/TP-PA(+) (n = 38) women were more likely to be older, have a prior history of sexually transmitted infections, and receive treatment for syphilis during pregnancy than women who were CIA(+)/RPR(-)/TP-PA(-) (all P < .005). Most pregnancies (189/194 [97.5%]) resulted in a live birth; there was no difference in birth outcomes according to TP-PA status and no stillbirths attributable to syphilis. Most pregnant women with discordant serology were CIA(+)/RPR(-)/TP-PA(-); more than half who were retested became CIA(-). CIA(+)/RPR(-)/TP-PA(-) serology in pregnancy is likely to be falsely positive. Reflexive testing of discordant specimens with TP-PA is important to stratify risk given the likelihood of false-positive results in this population.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1537-6591 1537-6591
DOI:	10.1093/cid/civ445