Evaluating congenital syphilis in a reverse sequence testing environment

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Abstract

Objectives: To examine the effect of maternal reverse-sequence (RS) syphilis screening on management of infants at risk for congenital syphilis (CS) using a standardized approach. Study design: A retrospective study from 2011 to 2014 at an academic medical center using RS testing, involving chemiluminescent immunoassay (CIA), rapid plasma reagin (RPR), and fluorescent treponemal antibody-absorption (FTA-ABS) assays for syphilis. Clinical management and outcomes of infants born to mothers with discordant (CIA+/RPR−/FTA+) serology were compared with national or internal guidelines. Results: Sixty-three infants were classified as discordant (n = 21), presumed false positive (CIA+/RPR−/FTA−; n = 16), or true positive (CIA+/RPR+; n = 26) based on maternal serology. Only 24% of cases in the discordant group underwent recommended full evaluation. None of the evaluated infants in the discordant group (n = 8) were diagnosed with CS. Conclusions: Management of infants with discordant maternal RS serology remained reliant on clinical judgment. In our high-risk population, RS testing did not identify additional cases of CS.

Original languageEnglish (US)
JournalJournal of Perinatology
DOIs
StatePublished - Jan 1 2019

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Congenital Syphilis
Reagins
Immunoassay
Serology
Mothers
Syphilis
Retrospective Studies
Guidelines
Antibodies
Population

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

@article{b9c8f8b158df4ca4b6fb305c632f9ea9,
title = "Evaluating congenital syphilis in a reverse sequence testing environment",
abstract = "Objectives: To examine the effect of maternal reverse-sequence (RS) syphilis screening on management of infants at risk for congenital syphilis (CS) using a standardized approach. Study design: A retrospective study from 2011 to 2014 at an academic medical center using RS testing, involving chemiluminescent immunoassay (CIA), rapid plasma reagin (RPR), and fluorescent treponemal antibody-absorption (FTA-ABS) assays for syphilis. Clinical management and outcomes of infants born to mothers with discordant (CIA+/RPR−/FTA+) serology were compared with national or internal guidelines. Results: Sixty-three infants were classified as discordant (n = 21), presumed false positive (CIA+/RPR−/FTA−; n = 16), or true positive (CIA+/RPR+; n = 26) based on maternal serology. Only 24{\%} of cases in the discordant group underwent recommended full evaluation. None of the evaluated infants in the discordant group (n = 8) were diagnosed with CS. Conclusions: Management of infants with discordant maternal RS serology remained reliant on clinical judgment. In our high-risk population, RS testing did not identify additional cases of CS.",
author = "May Chen and Akinboyo, {Ibukunoluwa C.} and Sue, {Paul K.} and Donohue, {Pamela Kimzey} and Ghanem, {Khalil G} and Barbara Detrick and Witter, {Frank R} and Page, {Kathleen R} and Ravit Boger and Golden, {W Christopher}",
year = "2019",
month = "1",
day = "1",
doi = "10.1038/s41372-019-0387-9",
language = "English (US)",
journal = "Journal of Perinatology",
issn = "0743-8346",
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T1 - Evaluating congenital syphilis in a reverse sequence testing environment

AU - Chen, May

AU - Akinboyo, Ibukunoluwa C.

AU - Sue, Paul K.

AU - Donohue, Pamela Kimzey

AU - Ghanem, Khalil G

AU - Detrick, Barbara

AU - Witter, Frank R

AU - Page, Kathleen R

AU - Boger, Ravit

AU - Golden, W Christopher

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: To examine the effect of maternal reverse-sequence (RS) syphilis screening on management of infants at risk for congenital syphilis (CS) using a standardized approach. Study design: A retrospective study from 2011 to 2014 at an academic medical center using RS testing, involving chemiluminescent immunoassay (CIA), rapid plasma reagin (RPR), and fluorescent treponemal antibody-absorption (FTA-ABS) assays for syphilis. Clinical management and outcomes of infants born to mothers with discordant (CIA+/RPR−/FTA+) serology were compared with national or internal guidelines. Results: Sixty-three infants were classified as discordant (n = 21), presumed false positive (CIA+/RPR−/FTA−; n = 16), or true positive (CIA+/RPR+; n = 26) based on maternal serology. Only 24% of cases in the discordant group underwent recommended full evaluation. None of the evaluated infants in the discordant group (n = 8) were diagnosed with CS. Conclusions: Management of infants with discordant maternal RS serology remained reliant on clinical judgment. In our high-risk population, RS testing did not identify additional cases of CS.

AB - Objectives: To examine the effect of maternal reverse-sequence (RS) syphilis screening on management of infants at risk for congenital syphilis (CS) using a standardized approach. Study design: A retrospective study from 2011 to 2014 at an academic medical center using RS testing, involving chemiluminescent immunoassay (CIA), rapid plasma reagin (RPR), and fluorescent treponemal antibody-absorption (FTA-ABS) assays for syphilis. Clinical management and outcomes of infants born to mothers with discordant (CIA+/RPR−/FTA+) serology were compared with national or internal guidelines. Results: Sixty-three infants were classified as discordant (n = 21), presumed false positive (CIA+/RPR−/FTA−; n = 16), or true positive (CIA+/RPR+; n = 26) based on maternal serology. Only 24% of cases in the discordant group underwent recommended full evaluation. None of the evaluated infants in the discordant group (n = 8) were diagnosed with CS. Conclusions: Management of infants with discordant maternal RS serology remained reliant on clinical judgment. In our high-risk population, RS testing did not identify additional cases of CS.

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