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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Vydané v:Clinical infectious diseases Ročník 61; číslo 7; s. 1049
Hlavní autori: Mmeje, Okeoma, Chow, Joan M, Davidson, Lisette, Shieh, Jennifer, Schapiro, Jeffrey M, Park, Ina U
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States 01.10.2015
Predmet:
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.
Bibliografia:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:1537-6591
1537-6591
DOI:10.1093/cid/civ445