Discordant Syphilis Immunoassays in Pregnancy: Perinatal Outcomes and Implications for Clinical Management
Discordant Syphilis Immunoassays in Pregnancy: Perinatal Outcomes and Implications for Clinical Management
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DOI：
10.1093/cid/civ445
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发表时间：
2015-10-01
影响因子：
11.8
通讯作者：
Park, Ina U.
中科院分区：
文献类型：
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作者：
Mmeje, Okeoma;Chow, Joan M.;Park, Ina U.
背景资料。反向序列算法通常用于大量实验室的产前梅毒筛查，首先是梅毒螺旋体试验，如化学发光免疫分析(CIA)，然后是CIA阳性(CIA(+))标本的快速血浆反应素试验(RPR)。不一致的血清学(CIA(+)/RPR-)对母婴结局的临床意义尚不清楚。自2007年8月至2010年8月，在北加州凯撒永久医院，所有梅毒螺旋体血清学不一致的孕妇接受梅毒螺旋体颗粒凝集试验(TP-PA)的反射性试验，并被归类为“TP-PA确诊”(CIA(+)/RPR-/TP-PA(+))或“孤立CIA阳性”(CIA(+)/RPR-/TP-PA(-))。从病历中提取人口学变量和临床数据，并通过TP-PA状态进行比较。194例孕妇中，CIA(+)/RPR-/TP-PA(-)156例(80%)，CIA(+)/RPR-/TP-PA(+)38例(20%)。在重新测试的77名(49%)CIA(+)/RPR-/TP-PA(-)女性中，53%成为CIA(-)。CIA(+)/RPR-/TP-PA(+)(n=38)妇女比CIA(+)/RPR-/TP-PA(-)妇女更有可能年龄更大，有性传播感染史，并在怀孕期间接受梅毒治疗(均为P<；.005)。大多数妊娠(189/194[97.5%])导致活产；不同TP-PA状态的分娩结局没有差异，没有死胎可归因于梅毒。大多数血清学不一致的孕妇是CIA(+)/RPR-/TP-PA(-)；超过一半的复检成为CIA(-)。孕期CIA(+)/RPR-/TP-PA(-)血清学可能为假阳性。考虑到这一人群中假阳性结果的可能性，用TP-PA对不一致的标本进行反射性检测对于风险分层很重要。
Background. 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.Methods. 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.Results. 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.Conclusions. 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.