Objectives In resource-limited settings, screening pregnant women for syphilis using rapid diagnostic tests (RDTs) is a key tool in the prevention of congenital syphilis. However, most syphilis RDTs detect only treponemal antibodies (T-RDT), meaning antibiotics may be provided unnecessarily to previously treated pregnant women, particularly in non-venereal treponematoses endemic regions. We estimated the potential reduction in overtreatment when comparing T-RDT (SD Bioline) to a newer rapid test (Dual Path Platform (DPP) Screen and Confirm Assay, Chembio) detecting both treponemal and non-treponemal antibodies.
Methods Pregnant women in Déou, Burkina Faso, screened for syphilis during antenatal care (ANC) visits were prospectively enrolled in the study after providing consent. DPP and T-RDT tests were performed on whole blood specimens. Plasma was tested in an international reference laboratory by Treponema pallidum passive particle agglutination (TPPA) and quantitative rapid plasma reagin (RPR). Presumptive active syphilis was defined as a result that was both TPPA and RPR reactive.
Results Of the 242 pregnant women included in the study, 91 (37.6%) had presumptive active syphilis and 19.0% had RPR titres ≥8. DPP testing did not reduce the number of pregnant women who would have been overtreated compared with T-RDT (0.0% vs 2.5%; p=0.218) and had a higher proportion of underdiagnosis (48.4% vs 2.2%; p<0.001). Seven women with high RPR titres ≥8 would not have received treatment had only DPP testing been used.
Conclusion In the first evaluation comparing DPP with traditional screening methods in pregnant women, we saw no reduction in unnecessarily treated syphilis and an underestimation of those needing treatment. High seroprevalence in the population may indicate the presence of other treponemal infections in the area, and further study of DPP in a variety of Sahelian and other contexts is warranted.
- diagnostic test
- pregnant women
- antenatal care
- treponemal infections
- Burkina Faso
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Handling editor Catherine A Ison
Contributors Céline Langendorf, Céline Lastrucci, KB and TC conceived of and designed the work; Céline Langendorf, Céline Lastrucci, KB, M-HK and IS-B were responsible for the acquisition, analysis and interpretation of the data; Céline Langendorf and Céline Lastrucci prepared the manuscript, and TC revised the work critically for important intellectual content and provided final approval of the version to be published. All authors agree to be accountable for all aspects of the work.
Funding Médecins Sans Frontières funded this study in its entirety. Epicentre receives core funding from Médecins Sans Frontières, and no pharmaceutical or other external grants were received during the development or implementation of this study.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study was approved by the Comité de Protection des Personnes (Saint Germain-en-Laye, France; approval number 14019), the Comité d’Ethique du Ministère de la Santé Publique in Burkina Faso (2014-3-021) and the Institutional Review Board of the ITM (Belgium, approval number 935/14).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All data are available upon reasonable request to the corresponding author at the contact provided.
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