Serologic Testing for Syphilis in the United States: A Cost-Effectiveness Analysis of Two Screening Algorithms

Owusu-Edusei, Kwame; Peterman, Thomas A.; Ballard, Ronald C.

doi:10.1097/olq.0b013e3181ec51f1

Cited by 76 publications

(62 citation statements)

References 23 publications

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“…Third, the results from this study do not address whether screening with a treponema-specific assay is clinically or economically advantageous compared to screening by RPR assay. Past reports have suggested advantages and limitations to both strategies (8,9), and further studies are needed. Interestingly, among the 303 serum samples tested in our study, 97 (32.0%) were positive by FTA assay versus 94 (31.0%) by the panel and only 66 (21.8%) by RPR assay.…”

Section: Discussionmentioning

confidence: 99%

Treponema-Specific Tests for Serodiagnosis of Syphilis: Comparative Evaluation of Seven Assays

2011

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Section: Discussionmentioning

confidence: 99%

Treponema-Specific Tests for Serodiagnosis of Syphilis: Comparative Evaluation of Seven Assays

2011

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“…Furthermore, initial setup costs as well as ongoing laboratory operational costs may be also be higher (49,50).…”

Section: Diagnostic Algorithmsmentioning

confidence: 99%

“…Owusu-Edusei conducted a cohort decision analysis to estimate the expected costs and effects of the traditional and reverse algorithms in a low-prevalence setting such as would be found in the United States (50). They demonstrated that, while the reverse algorithm resulted in the treatment of 99% of syphilis cases, it was more expensive overall because it resulted in a significantly higher number of follow-ups (three times as many) and overtreatment.…”

Section: Comparison Of the Three Algorithmsmentioning

confidence: 99%

Recent Trends in the Serologic Diagnosis of Syphilis

Morshed

Singh

2014

Clin. Vaccine Immunol.

158

156

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bComplexities in the diagnosis of syphilis continue to challenge clinicians. While direct tests (e.g., microscopy or PCR) are helpful in early syphilis, the mainstay of diagnosis remains serologic tests. The traditional algorithm using a nontreponemal test (NTT) followed by a treponemal test (TT) remains the standard in many parts of the world. More recently, the ability to automate the TT has led to the increasingly widespread use of reverse algorithms using treponemal enzyme immunoassays (EIAs). Rapid, point-of-care TTs are in widespread use in developing countries because of low cost, ease of use, and reasonable performance. However, none of the current diagnostic algorithms are able to distinguish current from previously treated infections. In addition, the reversal of traditional syphilis algorithms has led to uncertainty in the clinical management of patients. The interpretation of syphilis tests is further complicated by the lack of a reliable gold standard for syphilis diagnostics, and the newer tests can result in false-positive reactions similar to those seen with older tests. Little progress has been made in the area of serologic diagnostics for congenital syphilis, which requires assessment of maternal treatment and serologic response as well as clinical and laboratory investigation of the neonate for appropriate management. The diagnosis of neurosyphilis continues to require the collection of cerebrospinal fluid for a combination of NTT and TT, and, while newer treponemal EIAs look promising, more studies are needed to confirm their utility. This article reviews current tests and discusses current controversies in syphilis diagnosis, with a focus on serologic tests.

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“…With the increased availability of automated assays for treponemal antibodies, however, many laboratories have shifted to a "treponemal-first" algorithm for syphilis testing. The merits of the 2 approaches have been debated in the literature in terms of clinical utility and cost-effectiveness (1,2 ). The main difference between the 2 approaches is the identification of treponemal-positive, RPR-negative patients when a treponemal-first algorithm is used (3 ).…”

Section: To the Editormentioning

confidence: 99%

The Impact of Analytical Sensitivity on Screening Algorithms for Syphilis

Zhang¹,

Yen‐Lieberman²,

Means³

et al. 2012

Clinical Chemistry

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Serologic Testing for Syphilis in the United States: A Cost-Effectiveness Analysis of Two Screening Algorithms

Abstract: The Treponemal-First option costs slightly more and results in more unnecessary treatment.

Cited by 76 publications

References 23 publications

Treponema-Specific Tests for Serodiagnosis of Syphilis: Comparative Evaluation of Seven Assays

Treponema-Specific Tests for Serodiagnosis of Syphilis: Comparative Evaluation of Seven Assays

Recent Trends in the Serologic Diagnosis of Syphilis

The Impact of Analytical Sensitivity on Screening Algorithms for Syphilis

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