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On-site rapid antenatal syphilis screening with an immunochromatographic strip improves case detection and treatment in rural South African clinics.
Sex Transm Dis. 2007 Jul; 34(7 Suppl):S55-60.ST

Abstract

OBJECTIVES

Congenital syphilis is a significant cause of adverse pregnancy outcomes. In South Africa, rural clinics perform antenatal screening offsite, but unreliable transport and poor client follow up impede effective treatment. We compared 3 syphilis screening strategies at rural clinics: on-site rapid plasma reagin (RPR), on-site treponemal immunochromatographic strip (ICS) test, and the standard practice offsite RPR with Treponema pallidum hemagglutination assay (RPR/TPHA).

METHODS

Eight rural clinics performed the on-site RPR and ICS tests and provided immediate treatment. Results were compared with RPR/TPHA at a reference laboratory. Chart reviews at 8 standard practice clinics established diagnosis and treatment rates for offsite RPR/TPHA.

FINDINGS

Seventy-nine (6.3%) of 1,250 women screened on-site had active syphilis according to the reference laboratory. The on-site ICS resulted in the highest percentage of pregnant women correctly diagnosed and treated for syphilis (89.4% ICS, 63.9% on-site RPR, 60.8% offsite RPR/TPHA). The on-site RPR had low sensitivity (71.4% for high-titer syphilis). The offsite approach suffered from poor client return rates. One percent of women screened with the ICS may have received penicillin unnecessarily. There were no adverse treatment outcomes.

CONCLUSIONS

The on-site ICS test can reduce syphilis-related adverse outcomes of pregnancy through accurate diagnosis and immediate treatment of pregnant women with syphilis.

Authors+Show Affiliations

Centers for Disease Control and Prevention, Atlanta, Georgia, USA. RBronzan@msn.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article

Language

eng

PubMed ID

17139234

Citation

Bronzan, Rachel N., et al. "On-site Rapid Antenatal Syphilis Screening With an Immunochromatographic Strip Improves Case Detection and Treatment in Rural South African Clinics." Sexually Transmitted Diseases, vol. 34, no. 7 Suppl, 2007, pp. S55-60.
Bronzan RN, Mwesigwa-Kayongo DC, Narkunas D, et al. On-site rapid antenatal syphilis screening with an immunochromatographic strip improves case detection and treatment in rural South African clinics. Sex Transm Dis. 2007;34(7 Suppl):S55-60.
Bronzan, R. N., Mwesigwa-Kayongo, D. C., Narkunas, D., Schmid, G. P., Neilsen, G. A., Ballard, R. C., Karuhije, P., Ddamba, J., Nombekela, E., Hoyi, G., Dlali, P., Makwedini, N., Fehler, H. G., Blandford, J. M., & Ryan, C. (2007). On-site rapid antenatal syphilis screening with an immunochromatographic strip improves case detection and treatment in rural South African clinics. Sexually Transmitted Diseases, 34(7 Suppl), S55-60.
Bronzan RN, et al. On-site Rapid Antenatal Syphilis Screening With an Immunochromatographic Strip Improves Case Detection and Treatment in Rural South African Clinics. Sex Transm Dis. 2007;34(7 Suppl):S55-60. PubMed PMID: 17139234.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - On-site rapid antenatal syphilis screening with an immunochromatographic strip improves case detection and treatment in rural South African clinics. AU - Bronzan,Rachel N, AU - Mwesigwa-Kayongo,Dan C, AU - Narkunas,Diane, AU - Schmid,George P, AU - Neilsen,Graham A, AU - Ballard,Ronald C, AU - Karuhije,Pascale, AU - Ddamba,James, AU - Nombekela,Eric, AU - Hoyi,Gideon, AU - Dlali,Pumla, AU - Makwedini,Nomalanga, AU - Fehler,H Glenda, AU - Blandford,John M, AU - Ryan,Caroline, PY - 2006/12/2/pubmed PY - 2007/7/27/medline PY - 2006/12/2/entrez SP - S55 EP - 60 JF - Sexually transmitted diseases JO - Sex Transm Dis VL - 34 IS - 7 Suppl N2 - OBJECTIVES: Congenital syphilis is a significant cause of adverse pregnancy outcomes. In South Africa, rural clinics perform antenatal screening offsite, but unreliable transport and poor client follow up impede effective treatment. We compared 3 syphilis screening strategies at rural clinics: on-site rapid plasma reagin (RPR), on-site treponemal immunochromatographic strip (ICS) test, and the standard practice offsite RPR with Treponema pallidum hemagglutination assay (RPR/TPHA). METHODS: Eight rural clinics performed the on-site RPR and ICS tests and provided immediate treatment. Results were compared with RPR/TPHA at a reference laboratory. Chart reviews at 8 standard practice clinics established diagnosis and treatment rates for offsite RPR/TPHA. FINDINGS: Seventy-nine (6.3%) of 1,250 women screened on-site had active syphilis according to the reference laboratory. The on-site ICS resulted in the highest percentage of pregnant women correctly diagnosed and treated for syphilis (89.4% ICS, 63.9% on-site RPR, 60.8% offsite RPR/TPHA). The on-site RPR had low sensitivity (71.4% for high-titer syphilis). The offsite approach suffered from poor client return rates. One percent of women screened with the ICS may have received penicillin unnecessarily. There were no adverse treatment outcomes. CONCLUSIONS: The on-site ICS test can reduce syphilis-related adverse outcomes of pregnancy through accurate diagnosis and immediate treatment of pregnant women with syphilis. SN - 0148-5717 UR - https://www.unboundmedicine.com/medline/citation/17139234/On_site_rapid_antenatal_syphilis_screening_with_an_immunochromatographic_strip_improves_case_detection_and_treatment_in_rural_South_African_clinics_ L2 - https://doi.org/10.1097/01.olq.0000245987.78067.0c DB - PRIME DP - Unbound Medicine ER -