Reverse Sequence Screening for Syphilis
Syphilis is a chronic, sexually transmitted disease caused by the spirochete, Treponema pallidum. The clinical manifestations of syphilis are often non-specific and may be progressive if the disease is not diagnosed and treated appropriately.
According to a recent article in AACC, authored by Elitza Theel, Ph.D., Director of the Infectious Disease Serology Laboratory at Mayo Clinic, and Matt Binnicker, Ph.D., Director of the Clinical Virology Laboratory in the Division of Clinical Microbiology at Mayo Clinic, many clinical laboratories are breaking from the current syphilis screening algorithm recommended by the Centers for Disease Control and Prevention (CDC) in order to use more specific, automated assays. However, many providers are still confused about how to interpret test results and what follow-up testing, if any, is required. Using four case study examples, Dr. Theel and Dr. Binnicker's article reviews current syphilis assays and explains how laboratories can implement the new algorithm and advise clinicians.
Based on the limitations of both the traditional and reverse sequence screening algorithms, there several areas of interest to be considered for diagnosing syphilis. These include:
- Refine the serologic testing algorithm, with the European Centre for Disease Prevention and Control (ECDC) recently recommending that a treponemal immunoassay be used to screen samples, with sera testing reactive by the initial test being tested by a second, different treponemal assay for confirmation.
- Develop rapid and sensitive molecular assays. However, reports suggest that molecular detection of T. pallidum may be useful during early disease before patients seroconvert, but likely is of limited value in later stages of disease.
- Develop sensitive, point-of-care (POC) diagnostic tests to enhance detection of early/primary syphilis.
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