Rapid Syphilis Testing in the Real World

Background: In CY 2015, the Pennsylvania (PA) STD Program reported a 52% increase in reported Primary & Secondary (P&S) Syphilis from 223 cases reported in CY 2014 to an estimated 341 cases reported in CY 2015. The 52% percent increase, represents the highest number of reported cases in the Project Area (PA exclusive of Philadelphia) in the last 12 years. Individuals, under age 30 account for 58% of reported P&S Cases. In response to the increase, the Project Area implemented a phased rollout of the Trinity Bio Tech Syphilis Health Check, Rapid Syphilis Test (RST).

Methods: The rollout of the RST includes gay camp ground outreach, STD clinics focused on the MSM population, high yield chlamydia and gonorrhea screening sites, and field-based testing for critical period syphilis contacts, suspects, and associates.

Results: During phase one and two of the RST rollout, the STD Program performed parallel testing of clients using both the RST and traditional lab-based syphilis testing using a reverse syphilis algorithm (RSA). Of the 698 clients tested, 4.1% (29 individuals) tested positive using RST, of those 52% were confirmed through RSA. During this RST rollout, the STD Program documented 100% concurrence between the negative RST as compared to the negative RSA. [This algorithm is based on the guidelines established by the Centers for Disease Control and Prevention, published in MMWR 60(5), February 11, 2011.]

Conclusions: The RST is ideal for use in outreach and other venues where syphilis testing is being offered to high-risk individuals and where the follow-up with those individuals who test positive is difficult. Due to the high false positive rate of the RST, the RST result should not be used exclusively to make a syphilis diagnosis. The STD Program requires that all positive RST results be confirmed with a RSA test.