Evaluation of Five-Year Rapid Plasma Reagin (RPR) and Treponema Pallidum Hemagglutination Assay (TPHA) Results at a University Hospital

Abstract

Aim: Syphilis is a multisystem disease, often sexually transmitted, caused by Treponema pallidum. Serological tests are often used in the diagnosis of the disease and treatment follow-up. In serological diagnosis, it is essential to confirm the result with treponemal tests after screening with nontreponemal tests in the traditional algorithm. This study aimed to retrospectively evaluate the five-year Rapid Plasma Reagin (RPR) and Treponema Pallidum Hemagglutination Assay (TPHA) test results at xxx University Hospital. Material and Methods: 10719 test results of a total of 6516 patients sent to xxx Serology Laboratory for syphilis diagnosis and follow-up between January 2018 and December 2022 were evaluated retrospectively. RPR (Monlabtest, England) and TPHA (Plasmatec, England) tests on serums were carried out in accordance with the recommendations of the manufacturers. Results: Of the 6516 patients with clinical suspicion of syphilis, only TPHA was requested from 2622 (40.24%), only RPR was requested from 696 (10.68%), and both TPHA and RPR were requested from 3198 (49.08%). Positivity was detected in nine (0.34%) of the patients for whom TPHA was requested and in six (0.86%) of the patients for whom only RPR was requested. Of the patients for whom both TPHA and RPR were requested eight (0.25%) were found RPR positive-TPHA negative, 71 (2.22%) were found RPR positive-TPHA positive, and 3038 (95.0%) were found RPR negative- TPHA negative, 81 (2.53%) were found RPR negative- TPHA positive. According to age groups, RPR and TPHA requests were most frequently in the 19-30 age group and although 3003 test requests were made, RPR and TPHA positivity was detected more in the 31-40 age group (4.32%) than other age groups. A significant difference was found between gendersas a result of the statistical analysis made according to age groups (p<0.001). Conclusion: In line with our study, the significant increase in syphilis infection, especially in the young and middle age group, suggests that awareness of sexually transmitted diseases should be increased, especially among young people.

Keywords

• Serological test;
• syphilis;
• Treponema pallidum

Bir Üniversite Hastanesinde Beş Yıllık Rapid Plasma Reagin (RPR) ve Treponema Pallidum Hemaglutinasyon Assay (TPHA) Sonuçlarının Değerlendirilmesi

Abstract

Amaç: Sifilis, Treponema pallidum’ un neden olduğu sıklıkla cinsel yolla bulaşan multisistemik bir hastalıktır. Hastalığın tanısında ve tedavi takibinde sıklıkla serolojik testler kullanılır. Serolojik tanıda geleneksel algoritmada nontreponemal testlerle yapılan taramanın ardından sonucun treponemal testlerle doğrulanması esastır. Bu çalışmada Ondokuz Mayıs Üniversitesi Hastanesi’nde beş yıllık Rapid Plasma Reagin (RPR) ve Treponema Pallidum Hemaglutinasyon Assay (TPHA) test sonuçlarının retrospektif olarak değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Ocak 2018- Aralık 2022 tarihleri arasında Ondokuz Mayıs Üniversitesi Tıp Fakültesi Seroloji Laboratuvarı’na sifilis tanı ve takibi amacıyla gönderilen toplam 6516 hastaya ait 10719 test sonucu retrospektif olarak değerlendirilmiştir. Serumlarda RPR (Monlabtest, İngiltere) ve TPHA (Plasmatec, İngiltere) testleri, üretici firmaların önerileri doğrultusunda çalışılmıştır. Bulgular: Klinik sifilis şüpheli 6516 hastanın 2622 (%40,24)’sinden sadece TPHA, 696 (%10,68)’sından sadece RPR, 3198 (%49,08)’inden ise hem TPHA hem RPR istenmiştir. Sadece TPHA istenen hastalardan dokuzunda (%0,34), sadece RPR istenen hastaların ise altısında (%0,86) pozitiflik saptanmıştır. Hem TPHA hem RPR istenen hastaların sekizinde (%0,25) RPR pozitif-TPHA negatif, 71 (%2,22)’inde RPR pozitif-TPHA pozitif, 3038 (%95)’inde ise RPR negatif-TPHA negatif, 81 (%2,53)’inde RPR negatif-TPHA pozitif bulunmuştur. Yaş gruplarına göre RPR ve TPHA istemi en sık 19-30 yaş grubunda olup 3003 adet test istemi yapılmasına karşın, RPR ve TPHA pozitifliği 31-40 yaş grubunda (%4,32) diğer yaş gruplarına göre daha fazla saptanmıştır. Cinsiyetler arasında, yaş gruplarına göre yapılan istatistiksel analiz sonucu anlamlı fark saptanmıştır (p<0,001). Sonuç: Yaptığımız çalışma doğrultusunda sifilis enfeksiyonunda özellikle genç-orta yaş grubundaki anlamlı yükseklik, cinsel yolla bulaşan hastalıklar için özellikle gençlere yönelik farkındalığın artırılmasının gerektiğini düşündürmektedir.

Keywords

• Serolojik test;
• sifilis
• Treponema pallidum

References

1. Zarakolu P. Sifilisin laboratuvar tanısında güncel gelişmeler. Mikrobiyol Bul. 2023; 57(1): 141-55. https://doi.org/10.5578/mb.20239912.
2. Adışen E, Öztaş M, Gürer MA. 1994-2006 yılları arasında izlediğimiz sifilizli hastaların demografik bulguları. Türkderm: deri hastalıklar ve frengi arşivi. 2008; 42: 9-12.
3. Satyaputra F, Hendry S, Braddick M, Sivabalan P, Norton R. The laboratory diagnosis of syphilis. J clin microbiol. 2021; 59(10) e0010021. https://doi.org/10.1128/JCM.00100-21.
4. Murray PR, Rosenthal KS, Pfaller MA. Tıbbi Mikrobiyoloji. 7. baskı. Ankara: Pelikan Kitapevi; 2016.
5. Sommese L, De Pascale MR, Capuano M, Napoli C. Efforts in blood safety: Integrated approach for serological diagnosis of syphilis. Asian J Transfus Sci. 2016; 10(1): 22-30. https://doi.org/10.4103/0973-6247.164267.
6. O'Byrne P, MacPherson P. Syphilis. BMJ. 2019; 365: l4159. https://doi.org/10.1136/bmj.l4159.
7. Peeling RW, Mabey D, Kamb ML, Chen XS, Radolf JD, Benzaken AS. Syphilis. Nat Rev Dis Primers. 2017; 12(3): 17073. https://doi.org/10.1038/nrdp.2017.73.
8. Janier M, Unemo M, Dupin N, Tiplica GS, Potočnik M, Patel R. 2020 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol 2021; 35(3): 574-88. https://doi.org/10.1111/jdv.16946.

9. Us DA, editör. Temel İmmünoloji ve Seroloji. Ankara: Hipokrat Kitabevi; 2016.
10. Binder SR, Theel ES. Syphilis testing algorithms: A review. World J Immunol. 2014; 4(1): 26–33. https://doi.org/10.5411/wji.v4.i1.26.
11. Tuddenham S, Katz S, Ghanem K. Syphilis laboratory guidelines: Performance characteristics of nontreponemal antibody tests. Clin Infect Dis. 2020; 71(Suppl 1): 21–42. https://doi.org/10.1093/cid/ciaa306.
12. Forrestel AK, Kovarik CL, Katz KA. Sexually acquired syphilis: Laboratory diagnosis, management, and prevention. J Am Acad Dermatol. 2020; 82(1): 17–28. https://doi.org/10.1016/j.jaad.2019.02.074.
13. Luo Y, Xie Y, Xiao Y. Laboratory diagnostic tools for syphilis: Current status and future prospects. Front Cell Infect Microbiol. 2021; 10: 574806. https://doi.org/10.3389/fcimb.2020.574806.
14. Baker-Zander SA, Roddy RE, Handsfield HH, Lukehart SA. IgG and IgM antibody reactivity to antigens of Treponema pallidum after treatment of syphilis. Sex Transm Dis, 1986; 13(4): 214-20. https://doi.org/10.1097/00007435-198610000-00002.
15. Gülseren A. Sifilizin serolojik tanısı. Turk Mikrobiyol Cemiy Derg. 2005; 35(1): 73-9.
16. Ziver T, Yüksel P, Güngördü Z, İzmirli S, Çelik DG, Abdelkareem A, ve ark. Sifiliz enfeksiyonlarının tanısında kullanılan Rapid Plasma Reagin (RPR) ve Treponema pallidum Hemaglutinasyon Assay (TPHA) test sonuçlarının 2005-2010 yılları arasındaki değerlendirilmesi. Turk Hij Den Biyol Derg. 2011; 68(1): 1-7.
17. Sönmez C. Sifiliz Serolojik Tanısı. Turk Mikrobiyol Cem Derg. 2018; 48(1): 72-7. https: //doi.org/10.5222/TMCD.2018.072.
18. Choi, R, Lee SG, Lee EH. Understanding utilization and seroprevalence of syphilis tests in local clinics and hospitals in Korea. Clin Lab. 2023; 69: 1-2. https://doi.org/10.7754/Clin.Lab.2022.220506.
19. Willand L, Ritter S, Reinhard B, Offergeld R, Hamouda O. Infektionsepidemiologische daten von blutspendern 2006: Bericht des Robert Koch-Instituts zu den meldungen nach section sign 22 transfusionsgesetz [HIV, HCV, HBV and syphilis infections among blood donors in Germany 2006. Report from the Robert Koch Institute in accordance with article 22 of the transfusion act]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2008; 51(8): 902-14. https://doi.org/10.1007/s00103-008-0612-8.
20. Bjekic M, Vlajinac H, Sipetis-Grujicic S. Characteristics of gonorrhea and syphilis cases among the Roma ethnic group in Belgrade, Serbia. Braz J Infect Dis. 2016; 20(4):349-53. https://doi.org/10.1016/j.bjid.2016.05.004.
21. Nogueira WP, Nogueira MF, Nogueira JDA, Freire MEM, Gir E, Silva ACDO. Syphilis in riverine communities: prevalence and associated factors. Rev Esc Enferm USP. 2020; 56: e20210258. https://doi.org/10.1590/1980-220X-REEUSP-2021-0258.
22. Marti-Pastor M, Olalla PGD, Barbera MJ, Manzardo C, Ocana I, Knobel H, et al. Epidemiology of infections by HIV, syphilis, gonorrhea and lymphogranuloma venereum in Barcelona city: a population-based incidence study. BMC Public Health. 2015; 15(1): 1-8. https://doi.org/10.1186/s12889-015-2344-7.
23. Adaleti R, Kansak N, Aslan M, Balkose G, Toptan H, Dincer SD, ve ark. Comparison of syphilis seropositivity between non-immigrant and immigrant populations in the Anatolian side of Istanbul, Turkiye: Results of five-years retrospective study. North clin Istanb. 2022; 9(6): 590-4. https://doi.org/10.14744/nci.2021.80688.
24. Kaur R, Gupta S, Sarangal R, Chopra D, Singh H. Are we moving from symptomatic to asymptomatic syphilis: A retrospective analysis. Indian J Sex Transm Dis AIDS. 2023; 44(1): 45-8. https://doi.org/10.4103/ijstd.ijstd_109_22.
25. Romero JD, Guillen SM, Rodriguez-Artalejo FJ, Ruiz-Galiana J, Canton R, De Lucas Ramos P, et al. Sexually transmitted infections in Spain: Current status. Rev Esp Quimioter. 2023; 36(5): 444-65. https://doi.org/10.37201/req/038.2023.
26. Seara-Morais GJ, Pousada BF, Escaleira FF, Doi AM, Welter EAR, Avelino-Silva VI. Mobility restrictions during the COVID-19 pandemic and reduced outpatient HIV and syphilis testing in Brazil. Braz J Infect Dis. 2023; 27(3): 102771. https://doi.org/10.1016/j.bjid.2023.102771.
27. Totten YR, Hardy BM, Bennett B, Rowlinson MC, Crowe S. Comparative performance of the reverse algorithm using architect syphilis TP versus the traditional algorithm using Rapid Plasma Reagin in Florida's Public Health testing population. Ann Lab Med. 2019; 39(4): 396-9. https://doi.org/10.3343/alm.2019.39.4.396.
28. Tong ML, Lin LR, Liu LL, Zhang HL, Huang SJ, Chen YY, et al. Analysis of 3 algorithms for syphilis serodiagnosis and implications for clinical management. Clin Infect Dis. 2014; 58(8): 1116-24. https://doi.org/10.1093/cid/ciu087.
29. Binnicker MJ. Which algorithm should be used to screen for syphilis? Curr Opin Infect Dis. 2012; 25(1): 79-85. https://doi.org/10.1097/QCO.0b013e32834e9a3c.
30. Morshed MG, Singh AE. Recent trends in the serologic diagnosis of syphilis. Clin Vaccine Immunol. 2015; 22(2): 137-47. https://doi.org/10.1128/CVI.00681-14.
31. Morshed MG. Current trend on syphilis diagnosis: issues and challenges. Adv Exp Med Biol. 2014; 808: 51-64. https://doi.org/10.1007/978-81-322-1774-9_5.
32. Park IU, Fakile YF, Chow JM, Gustafson KJ, Jost H, Schapiroet JM, et al. Performance of treponemal tests for the diagnosis of syphilis. Clin Infect Dis. 2019; 68(6): 913-8.