Point-of-Care Treponemal Tests for Neurosyphilis Diagnosis
- 1 January 2015
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Sexually Transmitted Diseases
- Vol. 42 (1), 48-52
- https://doi.org/10.1097/olq.0000000000000222
Abstract
Background The laboratory diagnosis of neurosyphilis rests upon identifying cerebrospinal fluid (CSF) abnormalities, including CSF–Venereal Disease Research Laboratory (VDRL) reactivity. The CSF-VDRL may not be available in the parts of the world where neurosyphilis is most common. Treponemal immunochromatographic strip tests (ICSTs) have been developed as point-of-care tests on blood for syphilis diagnosis in resource-limited settings. Methods We optimized 3 commercial ICSTs for performance on CSF and tested CSF samples from 217 patients with syphilis. The Syphicheck-WB test (Qualpro Diagnostics, Goa, India; “Syphicheck”) was chosen for further study based on agreement with CSF-VDRL test results. We determined CSF-Syphicheck titers for 152 samples. We modified the CSF-Syphicheck for point-of-care testing in a US sexually transmitted diseases clinic and compared results on 102 paired centrifuged and uncentrifuged CSF samples obtained in the laboratory to the results obtained at point of care; results of samples diluted 1:4 were compared in a subset. Results The diagnostic sensitivity of a reactive CSF-Syphicheck (62%–64%) and the diagnostic specificity of a CSF-Syphicheck titer at or above 1:4 (79%–81%) were equivalent to the CSF-VDRL (54%–69% sensitivity, 73%–75% specificity) for laboratory and clinical neurosyphilis diagnoses. The CSF-Syphicheck normalized after neurosyphilis therapy similarly to the CSF-VDRL. The modified CSF-Syphicheck performed well at the point of care, albeit with better performance on cell-free compared with uncentrifuged CSF. Conclusions Cerebrospinal fluid treponemal ICSTs hold promise for point-of-care neurosyphilis diagnosis in regions where the CSF-VDRL is not available. Further study should address the performance of CSF ICSTs in resource-limited settings.This publication has 11 references indexed in Scilit:
- Faculty Opinions recommendation of Sexually transmitted diseases treatment guidelines, 2010.Published by H1 Connect ,2014
- Comparison of the Cerebrospinal Fluid (CSF) Toluidine Red Unheated Serum Test and the CSF Rapid Plasma Reagin Test with the CSF Venereal Disease Research Laboratory Test for Diagnosis of Neurosyphilis among HIV-Negative Syphilis Patients in ChinaJournal of Clinical Microbiology, 2014
- Comparing the performance characteristics of CSF-TRUST and CSF-VDRL for syphilis: a cross-sectional studyBMJ Open, 2013
- The Rapid Plasma Reagin Test Cannot Replace the Venereal Disease Research Laboratory Test for Neurosyphilis DiagnosisSexually Transmitted Diseases, 2012
- The Performance of Cerebrospinal Fluid Treponemal-Specific Antibody Tests in NeurosyphilisSexually Transmitted Diseases, 2012
- Accelerating worldwide syphilis screening through rapid testing: a systematic reviewThe Lancet Infectious Diseases, 2010
- A Consequence of the Syphilis Epidemic Among Men Who Have Sex With Men (MSM): Neurosyphilis in Los Angeles, 2001–2004Sexually Transmitted Diseases, 2008
- Nontreponemal tests in the diagnosis of neurosyphilis: an evaluation of the Venereal Disease Research Laboratory (VDRL) and the Rapid Plasma Reagin (RPR) testsJournal of Clinical Laboratory Analysis, 2008
- Cerebrospinal Fluid Abnormalities in Patients with Syphilis: Association with Clinical and Laboratory FeaturesThe Journal of Infectious Diseases, 2004
- Significance of laboratory findings for the diagnosis of neurosyphilisInternational Journal of STD & AIDS, 2000