Evaluation of a rapid syphilis test in an emergency department setting in Detroit, Michigan

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Sexually transmitted diseases


BACKGROUND: Syphilis transmission can be prevented by prompt diagnosis and treatment of primary and secondary infection. We evaluated the performance of a point-of-care rapid syphilis treponemal test (RST) in an emergency department (ED) setting. METHODS: Between June 2015 and April 2016, men aged 18-34 years seeking services in a Detroit ED, and with no history of syphilis, were screened for syphilis with the RST, rapid plasma reagin (RPR) test, and Treponema pallidum particle agglutination assay (TP-PA). A positive reference standard was both a reactive RPR and a reactive TP-PA. We compared test results in self-reported MSM to non-MSM. RESULTS: Among 965 participants, 10.9% of RSTs were reactive in MSM and only 1.5% in non-MSM (p<0.001). Sensitivity of the RST was 76.9% and specificity was 99.0% (PPV 50.0%) compared to the positive reference standard. Three discordant specimens found negative with the RST but positive with the reference standard had an RPR titer of 1:1, compared with 10 specimens with concordant positive results that had a median RPR titer of 1:16. The RST sensitivity was 50.0% (PPV 68.4%) compared to the TP-PA test alone. Among men seeking care in an ED, the RST detected 76.9% of participants with a reactive RPR and TP-PA. CONCLUSIONS: The RST detected all of the participants with an RPR titer > 1:2 but less than 20% of participants with a positive TP-PA and negative RPR. The RST was useful to detect a high proportion of participants with an active syphilis in an urban ED.

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ePub ahead of print