The Significance of Isolated Reactive Treponemal Enzyme Immunoassay in the Diagnosis of Early Syphilis
The Significance of Isolated Reactive Treponemal Enzyme Immunoassay in the Diagnosis of Early Syphilis
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DOI：
10.1097/olq.0000000000000446
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发表时间：
2016-06-01
影响因子：
3.1
通讯作者：
Manavi, Kaveh
中科院分区：
文献类型：
--
作者：
Caswell, Rachel J.;Hathorn, Emma;Manavi, Kaveh
背景：梅毒梅毒筛查的梅毒螺旋体试验算法被广泛应用。在梅毒螺旋体酶免疫分析(EIA)呈反应而确证梅毒颗粒凝集试验为阴性的病例中，在识别早期梅毒与假阳性信号之间存在诊断挑战。方法：回顾2010年8月10日至2014年11月31日在伯明翰惠托尔街诊所进行的梅毒血清学检测结果。常规邀请单独EIA患者进行重复梅毒血清学检查。回顾了单独EIA患者的结果，并确定了在他们的重复试验中确认梅毒血清学阳性的比例。结果：共进行了121,724次梅毒筛查。在1561例血清反应性EIA患者中，有316例(占总反应性试验的20%)分离出了反应性EIA。对163例梅毒患者的重复梅毒血清学结果进行了回顾，其中106例仍为单纯反应性ETA，50例EIA阴性，7例(4.3%)确诊为反应性ETA。在7名患者中，有2名患者有早期梅毒感染的证据。1例早期梅毒患者需要重新检测分离的埃塔抗体的数量为81.5%(95%可信区间为22.9-671.4)。应独立评估感染或存在早期梅毒的风险，而不考虑梅毒筛查试验阴性或隔离的埃塔。
Background: The Treponemal test algorithm for syphilis screening is widely used. A diagnostic challenge between identifying early syphilis versus a false positive signal occurs in cases where the treponemal enzyme immunoassay (EIA) is reactive and confirmatory T pallidum particle agglutination assay is negative. We investigated the diagnostic outcome of isolated reactive EIA in patients attending a sexual health clinic.Methods: Results of syphilis serology tests carried out at Birmingham Whittall Street Clinic between August 10, 2010, and November 31, 2014, were reviewed. Cases with isolated EIA were routinely invited for repeat syphilis serology. Outcomes of patients with isolated EIA were reviewed and the proportion with confirmed positive syphilis serology on their repeat test identified. The number of isolated EIA cases needed to retest to identify 1 case of early syphilis was calculated.Results: A total of 121,724 syphilis screening tests were performed. Among the 1561 individual patients with reactive EIA sera, 316 (20% of total reactive tests) had isolated reactive EIA. Repeat syphilis serology results of 163 patients were reviewed; 106 patients remained with isolated reactive ETA, 50 had negative EIA test and 7 (4.3%) had confirmed reactive ETA. Of the 7 patients, 2 had evidence of early syphilis infection. The number of isolated ETA needed to retest to identify 1 case of early syphilis was 81.5 (95% confidence interval, 22.9-671.4).Conclusions: Routine recall of patients with isolated ETA sera is not warranted. Risk of acquisition or presence of early syphilis should be assessed independently and irrespective of a negative syphilis screening test or isolated ETA.