Point-of-Care Treponemal Tests for Neurosyphilis Diagnosis. Issue 1 (January 2015)

• Record Type: Journal Article
• Authors: Ho, Emily L.; Tantalo, Lauren C.; Jones, Trudy; Sahi, Sharon K.; Marra, Christina M.
• Is Part Of: Sexually transmitted diseases. Volume 42:Issue 1(2015)
• Publication Date: 2015-01
• Subjects: Sexually transmitted diseases -- Periodicals; Sexual health -- Periodicals; 616.951005
• DOI: 10.1097/OLQ.0000000000000222
• Languages: English
• ISSNs: 0148-5717

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background</title> <p>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.</p> </sec> <sec> <title>Methods</title> <p>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.</p> </sec> <sec> <title>Results</title> <p>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.</p> </sec> <sec> <title>Conclusions</title> <p>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.</p> </sec> </abstract>