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Sex differences in the significance of isolated reactive treponemal chemiluminescence immunoassay results
  1. Rohan I Bopage1,
  2. Ute Vollmer-Conna2,
  3. Antonia W Shand3,4,
  4. Jeffrey John Post1
  1. 1 Department of Infectious Diseases and The Albion Centre, Prince of Wales Hospital and Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
  2. 2 School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
  3. 3 Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia
  4. 4 Department of Maternal Fetal Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia
  1. Correspondence to Professor Jeffrey John Post, Department of Infectious Diseases, Prince of Wales Hospital, Randwick 2031, New South Wales, Australia;{at}


Objectives The significance of sera with isolated reactive treponemal chemiluminescence immunoassay (IRTCIA) results is unclear. Women have this phenotype more commonly than men. Most cohorts examining this phenotype have included predominantly men and have demonstrated evidence of past or subsequently confirmed syphilis infection in a significant proportion of cases. We hypothesised that a proportion of sera with IRTCIA results would be positive on immunoblot testing and that sera from women with IRTCIA would have different results in immunoblot testing than men.

Methods IRTCIA sera from a tertiary referral serology laboratory serving multiple clinical sites were analysed with a syphilis line immunoblot assay (LIA) and analysed by sex. Logistic regression was undertaken to assess factors associated with LIA status. Medical record review and descriptive analysis of a separate cohort of women with the IRTCIA phenotype from a single campus was also undertaken.

Results Overall, 19/63 (30.1%) subjects with the IRTCIA phenotype were positive in the LIA, including 13 men and 6 women. Women were significantly less likely to have definitive results (positive or negative) than men (p=0.015). Pregnant women were less likely than non-pregnant women to have a negative LIA result (OR 0.57; p=0.03). Record review of 22 different women with IRTCIA reactivity showed that 2/22 (9.1%) had HIV and previous syphilis infection, 15/22 (68.2%) were pregnant and 3 (13.6%) had autoimmune disease.

Conclusions A significant proportion of sera with IRTCIA results on serological tests are reactive on LIA testing and some may not be false positive results. The interpretation of IRTCIA results should be undertaken in conjunction with an assessment of factors such as sex, pregnancy, a history of syphilis and other STIs and syphilis risk.

  • syphilis
  • diagnosis
  • serology
  • testing
  • women

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  • Handling editor Catherine A Ison

  • Contributors JJP conceived of the study. RIB collected the data, performed the laboratory assays and wrote the first draft of the manuscript. UV-C designed and undertook the statistical analysis.

  • Funding The INNO-LIA Syphilis Score kits were provided as a gift by Asquith Diagnostics Pty. The donor had no influence in the design, conduct or analysis of the research or the writing of the manuscript.

  • Competing interests None declared.

  • Ethics approval South Eastern Sydney Local Health District Human Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.