LBe Past and Current Syphilis Diagnoses Among Treponema Pallidum EIA+/RPR- Patients with a High Rate of HIV Infection; Findings From Medical Record Review, New York City 2008-2009

Wednesday, March 10, 2010: 5:00 PM
Grand Ballroom C (M4) (Omni Hotel)
Dahlia Philips-Rodriguez, MD, Division of Infectious Disease, Beth Israel Medical Center, New York, NY, David Perlman, MD, Department of Medicine, Beth Israel Medical Center, New York, NY and Julia Schillinger, MD, MSc, NYC DOHMH Bureau of STD Control; CDC Division of STD Prevention, The New York City Department of Health and Mental Hygiene; US Centers for Disease Control and Prevention, New York, NY

Background: Increasingly, clinical laboratories screen for syphilis with a treponemal test (Treponema pallidum EIA; TpEIA), and if positive, RPR testing is done. This algorithm identifies TpEIA+/RPR non-reactive (-) persons who would not be identified by traditional RPR screening algorithms.  A confirmatory treponemal test (FTA) is then done.  Persons who are FTA+ are considered to have “evidence of past treated or untreated syphilis”, but the clinical implications of these test results are unclear.

Objectives: To help understand the meaning of these test results by reviewing medical records from TpEIA+/RPR- persons.

Methods: We reviewed medical records from patients with TpEIA+/RPR- at a New York City hospital from July 1 2008 - June 29, 2009.

Results: 404 patients had 511 TpEIA+/RPR-results.  A random sample of 150 records were sought, 128 (85%) reviewed. 121 were FTA+, 6 FTA-, 1 had no FTA.  Median age was 46 (range 21-93); 55% were male. Most were HIV-positive (male 70%;49/70, female 66%;38/58) or  HIV-status unknown (15%;19/128). Common screening reasons were: routine screening among HIV+ patients (52%; 66/128); psychiatric screening (18%;23/128). Almost half (47%; 60/128) had previous syphilis (80% were HIV-positive), 33% (42/128) had previous syphilis treatment (76% HIV-positive), and 34% (43/128) had previous reactive RPRs (88% HIV-positive). Only 2 patients were documented to have no previous reactive RPR, no syphilis history, nor treatment, however, 56 were missing information on >1 of these variables. Physicians considered 9/128 (7%) to have late latent syphilis, (3 HIV-positive, 2 HIV-negative, 4 unknown).

Conclusions: In this hospital, most TpEIA+/RPR- patients were HIV-infected and had past syphilis. There appear to be few untreated cases, but further evaluation/investigation is needed.

Implications for Programs, Policy, and/or Research: Additional investigations, including some of low risk populations (eg pregnant women), are needed to clarify the clinical implications of Tp-EIA+/RPR- results.

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