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The tradition algorithm approach underestimates the prevalence of serodiagnosis of syphilis in HIV-infected individuals.

Abstract Currently, there are three algorithms for screening of syphilis: traditional algorithm, reverse algorithm and European Centre for Disease Prevention and Control (ECDC) algorithm. To date, there is not a generally recognized diagnostic algorithm. When syphilis meets HIV, the situation is even more complex. To evaluate their screening performance and impact on the seroprevalence of syphilis in HIV-infected individuals, we conducted a cross-sectional study included 865 serum samples from HIV-infected patients in a tertiary hospital. Every sample (one per patient) was tested with toluidine red unheated serum test (TRUST), T. pallidum particle agglutination assay (TPPA), and Treponema pallidum enzyme immunoassay (TP-EIA) according to the manufacturer's instructions. The results of syphilis serological testing were interpreted following different algorithms respectively. We directly compared the traditional syphilis screening algorithm with the reverse syphilis screening algorithm in this unique population. The reverse algorithm achieved remarkable higher seroprevalence of syphilis than the traditional algorithm (24.9% vs. 14.2%, p < 0.0001). Compared to the reverse algorithm, the traditional algorithm also had a missed serodiagnosis rate of 42.8%. The total percentages of agreement and corresponding kappa values of tradition and ECDC algorithm compared with those of reverse algorithm were as follows: 89.4%,0.668; 99.8%, 0.994. There was a very good strength of agreement between the reverse and the ECDC algorithm. Our results supported the reverse (or ECDC) algorithm in screening of syphilis in HIV-infected populations. In addition, our study demonstrated that screening of HIV-populations using different algorithms may result in a statistically different seroprevalence of syphilis.
PMID
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Authors

Mayor MeshTerms

Algorithms

Keywords
Journal Title plos neglected tropical diseases
Publication Year Start



 

PMID- 28727773
OWN - NLM
STAT- MEDLINE
DA  - 20170720
DCOM- 20170809
LR  - 20170809
IS  - 1935-2735 (Electronic)
IS  - 1935-2727 (Linking)
VI  - 11
IP  - 7
DP  - 2017 Jul
TI  - The tradition algorithm approach underestimates the prevalence of serodiagnosis
      of syphilis in HIV-infected individuals.
PG  - e0005758
LID - 10.1371/journal.pntd.0005758 [doi]
AB  - Currently, there are three algorithms for screening of syphilis: traditional
      algorithm, reverse algorithm and European Centre for Disease Prevention and
      Control (ECDC) algorithm. To date, there is not a generally recognized diagnostic
      algorithm. When syphilis meets HIV, the situation is even more complex. To
      evaluate their screening performance and impact on the seroprevalence of syphilis
      in HIV-infected individuals, we conducted a cross-sectional study included 865
      serum samples from HIV-infected patients in a tertiary hospital. Every sample
      (one per patient) was tested with toluidine red unheated serum test (TRUST), T.
      pallidum particle agglutination assay (TPPA), and Treponema pallidum enzyme
      immunoassay (TP-EIA) according to the manufacturer's instructions. The results of
      syphilis serological testing were interpreted following different algorithms
      respectively. We directly compared the traditional syphilis screening algorithm
      with the reverse syphilis screening algorithm in this unique population. The
      reverse algorithm achieved remarkable higher seroprevalence of syphilis than the 
      traditional algorithm (24.9% vs. 14.2%, p &lt; 0.0001). Compared to the reverse
      algorithm, the traditional algorithm also had a missed serodiagnosis rate of
      42.8%. The total percentages of agreement and corresponding kappa values of
      tradition and ECDC algorithm compared with those of reverse algorithm were as
      follows: 89.4%,0.668; 99.8%, 0.994. There was a very good strength of agreement
      between the reverse and the ECDC algorithm. Our results supported the reverse (or
      ECDC) algorithm in screening of syphilis in HIV-infected populations. In
      addition, our study demonstrated that screening of HIV-populations using
      different algorithms may result in a statistically different seroprevalence of
      syphilis.
FAU - Chen, Bin
AU  - Chen B
AUID- ORCID: http://orcid.org/0000-0003-1553-2803
AD  - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,
      Collaborative Innovation Center for Diagnosis and Treatment of Infectious
      Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University,
      Hangzhou, China.
FAU - Peng, Xiuming
AU  - Peng X
AD  - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,
      Collaborative Innovation Center for Diagnosis and Treatment of Infectious
      Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University,
      Hangzhou, China.
FAU - Xie, Tiansheng
AU  - Xie T
AD  - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,
      Collaborative Innovation Center for Diagnosis and Treatment of Infectious
      Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University,
      Hangzhou, China.
FAU - Jin, Changzhong
AU  - Jin C
AD  - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,
      Collaborative Innovation Center for Diagnosis and Treatment of Infectious
      Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University,
      Hangzhou, China.
FAU - Liu, Fumin
AU  - Liu F
AD  - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,
      Collaborative Innovation Center for Diagnosis and Treatment of Infectious
      Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University,
      Hangzhou, China.
FAU - Wu, Nanping
AU  - Wu N
AD  - State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,
      Collaborative Innovation Center for Diagnosis and Treatment of Infectious
      Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University,
      Hangzhou, China.
LA  - eng
PT  - Comparative Study
PT  - Evaluation Studies
PT  - Journal Article
DEP - 20170720
PL  - United States
TA  - PLoS Negl Trop Dis
JT  - PLoS neglected tropical diseases
JID - 101291488
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Algorithms
MH  - Cross-Sectional Studies
MH  - HIV Infections/*complications
MH  - Humans
MH  - Male
MH  - Mass Screening/*methods
MH  - Middle Aged
MH  - Seroepidemiologic Studies
MH  - Serologic Tests/*methods
MH  - Syphilis/*diagnosis/*epidemiology
MH  - Tertiary Care Centers
MH  - Treponema pallidum/*immunology
MH  - Young Adult
PMC - PMC5538742
EDAT- 2017/07/21 06:00
MHDA- 2017/08/10 06:00
CRDT- 2017/07/21 06:00
PHST- 2017/03/22 [received]
PHST- 2017/06/29 [accepted]
PHST- 2017/08/01 [revised]
AID - 10.1371/journal.pntd.0005758 [doi]
AID - PNTD-D-17-00392 [pii]
PST - epublish
SO  - PLoS Negl Trop Dis. 2017 Jul 20;11(7):e0005758. doi:
      10.1371/journal.pntd.0005758. eCollection 2017 Jul.