Variability in Syphilis Laboratory Testing Practices-Connecticut, 2010

Background: National syphilis incidence rates have been climbing since 2001. Syphilis elimination efforts are complicated by an evolving diagnostic process including increased utilization of automated tests and a new screening algorithm. Knowledge of how traditional and new tests are being used and reported is essential to the collection of accurate public health surveillance data and diagnosis of infectious syphilis cases.

Objectives: To determine the type of syphilis testing and reporting performed by Connecticut laboratories. 

Methods: The Connecticut Department of Public Health conducted a survey of all 30 Connecticut laboratories to determine type of syphilis testing performed and reported, testing algorithm used, and number of tests performed in 2010.

Results: All 30 laboratories responded to the survey; 24/28 (86%) laboratories that test for syphilis performed over 258,000 initial screening tests in 2010. Of these 28 laboratories, 4 (14%) use an automated test and a new screening algorithm. Of the 24 laboratories that do not use automated tests, 15 (63%) send samples to a referral lab (11/15 to the state lab) for confirmatory testing. Over half of laboratories (54%) report only one of the minimum two tests (non-specific and specific) needed to diagnose syphilis. The majority of laboratories (79%) report positive results within the required 48 hours.       

Conclusions: Diagnostic testing and reporting practices are variable among Connecticut laboratories. Increasing use of automated tests introduces further complexity into already intricate diagnostic and reporting processes. An evaluation of Connecticut syphilis surveillance, including an audit of high volume testing facilities, is being performed to ensure no infectious cases are missed.

Implications for Programs, Policy, and Research: Health departments must determine how the changes in syphilis testing and screening will be recorded and monitored by the surveillance system. Laboratory personnel should be educated on the requirements for reporting positive results on the initial and confirmatory tests.