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Performance of the rapid plasma reagin and the rapid syphilis screening tests in the diagnosis of syphilis in field conditions in rural Africa
  1. B West1,
  2. G Walraven1,
  3. L Morison2,
  4. J Brouwers1,
  5. R Bailey1
  1. 1Reproductive Health Programme, MRC Laboratories, Farafenni and Fajara, PO Box 273, Banjul, Gambia
  2. 2London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
  1. Correspondence to:
 Dr B West, MRC Laboratories, PO Box 273, Banjul, Gambia;


Objectives: To assess the rapid plasma reagin (RPR) test performance in the field and to evaluate a new rapid syphilis test (RST) as a primary screen for syphilis.

Methods: 1325 women of reproductive age from rural communities in the Gambia were tested for syphilis seropositivity using a RPR 18 mm circle card and a RST strip. Within 1 week a repeat RPR and a TPHA test were carried out using standard techniques in the laboratory.

Results: Comparing field tests to a diagnosis of “active” syphilis defined as laboratory RPR and TPHA positive, the RPR test was 77.5% sensitive and 94.1% specific; the RST was 75.0% sensitive and 95.2% specific. The RST was easier to use and interpret than the RPR test especially where field conditions were difficult. In this setting with a low prevalence of syphilis in the community (3%), the chance of someone with a positive test being confirmed as having serologically active syphilis was less than 50% for both tests.

Conclusions: The appropriateness of syphilis screening using RPR testing in antenatal clinics and health centres should be questioned if there is a low prevalence in the population, conditions for testing are poor, and resources limited. There is still an urgent need for an appropriate rapid syphilis test for field use.

  • syphilis
  • rapid plasmin reagin
  • rapid syphilis test
  • field testing

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