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Onsite rapid antenatal syphilis screening with an immunochromatographic strip improves case detection and treatment in rural South African Clinics.
Sexually Transmitted Diseases:Volume 34(7) SupplementJuly 2007pp S55-S60.
Bronzan RN, Mwesigwa-Kayongo DC, Narkunas D, Schmid G, Neilsen GA, Ballard
RC, Karuhije P, Ddamba J, Nombekela E, Hoyi G, Dlali P, Makwedini
N, Fehler HG, Blanford JM, Ryan C.
Abstract
OBJECTIVES: Congenital syphilis is a significant cause of adverse pregnancy
outcomes. In South Africa, rural clinics perform antenatal screening offsite,
but unreliable transport and poor client follow up impede effective treatment.
We compared 3 syphilis screening strategies at rural clinics: on-site rapid
plasma reagin (RPR), on-site treponemal immunochromatographic strip (ICS)
test, and the standard practice offsite RPR with Treponema pallidum hemagglutination
assay (RPR/TPHA). METHODS: Eight rural clinics performed the on-site RPR and
ICS tests and provided immediate treatment. Results were compared with RPR/TPHA
at a reference laboratory. Chart reviews at 8 standard practice clinics established
diagnosis and treatment rates for offsite RPR/TPHA. FINDINGS: Seventy-nine
(6.3%) of 1,250 women screened on-site had active syphilis according to the
reference laboratory. The on-site ICS resulted in the highest percentage of
pregnant women correctly diagnosed and treated for syphilis (89.4% ICS, 63.9%
on-site RPR, 60.8% offsite RPR/TPHA). The on-site RPR had low sensitivity
(71.4% for high-titer syphilis). The offsite approach suffered from poor client
return rates. One percent of women screened with the ICS may have received
penicillin unnecessarily. There were no adverse treatment outcomes. CONCLUSIONS:
The on-site ICS test can reduce syphilis-related adverse outcomes of pregnancy
through accurate diagnosis and immediate treatment of pregnant women with
syphilis.