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Discordant Syphilis Immunoassays in Pregnancy: Perinatal Outcomes and Implications for Clinical Management.
Clin Infect Dis. 2015 Oct 01; 61(7):1049-53.CI

Abstract

BACKGROUND

The reverse sequence algorithm is often used for prenatal syphilis screening by high-volume laboratories, beginning with a treponemal test such as the chemiluminescence immunoassay (CIA), followed by testing of CIA-positive (CIA(+)) specimens with the rapid plasma reagin test (RPR). The clinical significance of discordant serology (CIA(+)/RPR(-)) for maternal and neonatal outcomes is unknown.

METHODS

From August 2007 to August 2010, all pregnant women at Kaiser Permanente Northern California with discordant treponemal serology underwent reflexive testing with Treponema pallidum particle agglutination assay (TP-PA) and were categorized as "TP-PA confirmed" (CIA(+)/RPR(-)/TP-PA(+)) or "isolated CIA positive" (CIA(+)/RPR(-)/TP-PA(-)). Demographic variables and clinical data were abstracted from the medical record and compared by TP-PA status.

RESULTS

Of 194 pregnant women, 156 (80%) were CIA(+)/RPR(-)/TP-PA(-) and 38 (20%) were CIA(+)/RPR(-)/TP-PA(+). Among the 77 (49%) CIA(+)/RPR(-)/TP-PA(-) women who were retested, 53% became CIA(-). CIA(+)/RPR(-)/TP-PA(+) (n = 38) women were more likely to be older, have a prior history of sexually transmitted infections, and receive treatment for syphilis during pregnancy than women who were CIA(+)/RPR(-)/TP-PA(-) (all P < .005). Most pregnancies (189/194 [97.5%]) resulted in a live birth; there was no difference in birth outcomes according to TP-PA status and no stillbirths attributable to syphilis.

CONCLUSIONS

Most pregnant women with discordant serology were CIA(+)/RPR(-)/TP-PA(-); more than half who were retested became CIA(-). CIA(+)/RPR(-)/TP-PA(-) serology in pregnancy is likely to be falsely positive. Reflexive testing of discordant specimens with TP-PA is important to stratify risk given the likelihood of false-positive results in this population.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor.Sexually Transmitted Disease Control Branch, Division of Communicable Disease Control, California Department of Public Health, Center for Infectious Diseases, Richmond.Department of Obstetrics and Gynecology, Oakland Medical Center.The Permanente Medical Group, Kaiser Permanente Northern California, Oakland.The Permanente Medical Group, Kaiser Permanente Northern California, Oakland.Sexually Transmitted Disease Control Branch, Division of Communicable Disease Control, California Department of Public Health, Center for Infectious Diseases, Richmond Department of Family and Community Medicine, University of California, San Francisco.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

26063719

Citation

Mmeje, Okeoma, et al. "Discordant Syphilis Immunoassays in Pregnancy: Perinatal Outcomes and Implications for Clinical Management." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 61, no. 7, 2015, pp. 1049-53.
Mmeje O, Chow JM, Davidson L, et al. Discordant Syphilis Immunoassays in Pregnancy: Perinatal Outcomes and Implications for Clinical Management. Clin Infect Dis. 2015;61(7):1049-53.
Mmeje, O., Chow, J. M., Davidson, L., Shieh, J., Schapiro, J. M., & Park, I. U. (2015). Discordant Syphilis Immunoassays in Pregnancy: Perinatal Outcomes and Implications for Clinical Management. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 61(7), 1049-53. https://doi.org/10.1093/cid/civ445
Mmeje O, et al. Discordant Syphilis Immunoassays in Pregnancy: Perinatal Outcomes and Implications for Clinical Management. Clin Infect Dis. 2015 Oct 1;61(7):1049-53. PubMed PMID: 26063719.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Discordant Syphilis Immunoassays in Pregnancy: Perinatal Outcomes and Implications for Clinical Management. AU - Mmeje,Okeoma, AU - Chow,Joan M, AU - Davidson,Lisette, AU - Shieh,Jennifer, AU - Schapiro,Jeffrey M, AU - Park,Ina U, Y1 - 2015/06/10/ PY - 2014/11/30/received PY - 2015/04/05/accepted PY - 2015/6/12/entrez PY - 2015/6/13/pubmed PY - 2016/6/1/medline KW - congenital syphilis KW - discordant treponemal serology KW - prenatal syphilis screening KW - prenatal syphilis treatment KW - treponemal immunoassay SP - 1049 EP - 53 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 61 IS - 7 N2 - BACKGROUND: The reverse sequence algorithm is often used for prenatal syphilis screening by high-volume laboratories, beginning with a treponemal test such as the chemiluminescence immunoassay (CIA), followed by testing of CIA-positive (CIA(+)) specimens with the rapid plasma reagin test (RPR). The clinical significance of discordant serology (CIA(+)/RPR(-)) for maternal and neonatal outcomes is unknown. METHODS: From August 2007 to August 2010, all pregnant women at Kaiser Permanente Northern California with discordant treponemal serology underwent reflexive testing with Treponema pallidum particle agglutination assay (TP-PA) and were categorized as "TP-PA confirmed" (CIA(+)/RPR(-)/TP-PA(+)) or "isolated CIA positive" (CIA(+)/RPR(-)/TP-PA(-)). Demographic variables and clinical data were abstracted from the medical record and compared by TP-PA status. RESULTS: Of 194 pregnant women, 156 (80%) were CIA(+)/RPR(-)/TP-PA(-) and 38 (20%) were CIA(+)/RPR(-)/TP-PA(+). Among the 77 (49%) CIA(+)/RPR(-)/TP-PA(-) women who were retested, 53% became CIA(-). CIA(+)/RPR(-)/TP-PA(+) (n = 38) women were more likely to be older, have a prior history of sexually transmitted infections, and receive treatment for syphilis during pregnancy than women who were CIA(+)/RPR(-)/TP-PA(-) (all P < .005). Most pregnancies (189/194 [97.5%]) resulted in a live birth; there was no difference in birth outcomes according to TP-PA status and no stillbirths attributable to syphilis. CONCLUSIONS: Most pregnant women with discordant serology were CIA(+)/RPR(-)/TP-PA(-); more than half who were retested became CIA(-). CIA(+)/RPR(-)/TP-PA(-) serology in pregnancy is likely to be falsely positive. Reflexive testing of discordant specimens with TP-PA is important to stratify risk given the likelihood of false-positive results in this population. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/26063719/Discordant_Syphilis_Immunoassays_in_Pregnancy:_Perinatal_Outcomes_and_Implications_for_Clinical_Management_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/civ445 DB - PRIME DP - Unbound Medicine ER -