The Experts below are selected from a list of 1161 Experts worldwide ranked by ideXlab platform
Trudy Jones - One of the best experts on this subject based on the ideXlab platform.
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the rapid plasma Reagin Test cannot replace the venereal disease research laboratory Test for neurosyphilis diagnosis
Sexually Transmitted Diseases, 2012Co-Authors: Christina M Marra, Clare L Maxwell, Lauren C Tantalo, Sharon K Sahi, Trudy JonesAbstract:Background The cerebrospinal fluid (CSF) Venereal Disease Research Laboratory (VDRL) Test is a mainstay for neurosyphilis diagnosis, but it lacks diagnostic sensitivity and is logistically complicated. The rapid plasma Reagin (RPR) Test is easier to perform, but its appropriateness for use on CSF is controversial. Methods RPR reactivity was determined for CSF from 149 individuals with syphilis using 2 methods. The CSF-RPR was performed according to the method for serum. The CSF-RPR-V was performed using the method recommended for the CSF-VDRL. Laboratory-defined neurosyphilis included reactive CSF-fluorescent treponemal antibody absorption Test and CSF white blood cells >20/uL. Symptomatic neurosyphilis was defined as vision loss or hearing loss. Results CSF-VDRL was reactive in 45 (30.2%) patients. Of these, 29 (64.4%) were CSF-RPR reactive and 37 (82.2%) were CSF-RPR-V reactive. There were no instances where the CSF-VDRL was nonreactive but the CSF-RPR or CSF-RPR-V was reactive. Among the 28 samples that were reactive in all 3 Tests, CSF-VDRL titers (median [IQR], 1:4 [1:4-1:16]) were significantly higher than CSF-RPR (1:2 [1:1-1:4], P = 0.0002) and CSF-RPR-V titers (1:4 [1:2-1:8], P = 0.01). The CSF RPR and the CSF-RPR-V Tests had lower sensitivities than the CSF-VDRL: 56.4% and 59.0% versus 71.8% for laboratory-diagnosed neurosyphilis and 51.5% and 57.6% versus 66.7% for symptomatic neurosyphilis. Conclusions Compared with the CSF-VDRL, the CSF-RPR has a high false-negative rate, thus not improving upon this known limitation of the CSF-VDRL for neurosyphilis diagnosis. Adapting the RPR procedure to mimic the CSF-VDRL decreased, but did not eliminate, the number of false negatives and did not avoid all the logistical complications of the CSF-VDRL.
Robert M Grant - One of the best experts on this subject based on the ideXlab platform.
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syphilis predicts hiv incidence among men and transgender women who have sex with men in a preexposure prophylaxis trial
Clinical Infectious Diseases, 2014Co-Authors: Marc M Solomon, Kenneth H Mayer, David V Glidden, Albert Y Liu, Vanessa Mcmahan, Juan V Guanira, Suwat Chariyalertsak, Telmo Fernandez, Robert M GrantAbstract:Background. Syphilis infection may potentiate transmission of human immunodeficiency virus (HIV). We sought to determine the extent to which HIV acquisition was associated with syphilis infection within an HIV preexposure prophylaxis (PrEP) trial and whether emtricitabine/tenofovir (FTC/TDF) modified that association. Methods. The Preexposure Prophylaxis Initiative (iPrEx) study randomly assigned 2499 HIV-seronegative men and transgender women who have sex with men (MSM) to receive oral daily FTC/TDF or placebo. Syphilis prevalence at screening and incidence during follow-up were measured. Hazard ratios for the effect of incident syphilis on HIV acquisition were calculated. The effect of FTC/TDF on incident syphilis and HIV acquisition was assessed. Results. Of 2499 individuals, 360 (14.4%) had a positive rapid plasma Reagin Test at screening; 333 (92.5%) had a positive confirmatory Test, which did not differ between the arms (FTC/TDF vs placebo, P= .81). The overall syphilis incidence during the trial was 7.3 cases per 100 person-years. There was no difference in syphilis incidence between the study arms (7.8 cases per 100 person-years for FTC/TDF vs 6.8 cases per 100 person-years for placebo, P= .304). HIV incidence varied by incident syphilis (2.8 cases per 100 person-years for no syphilis vs 8.0 cases per 100 personyears for incident syphilis), reflecting a hazard ratio of 2.6 (95% confidence interval, 1.6–4.4; P< .001). There was no evidence for interaction between randomization to the FTC/TDF arm and incident syphilis on HIV incidence. Conclusions. In HIV-seronegative MSM, syphilis infection was associated with HIV acquisition in this PrEP trial; a syphilis diagnosis should prompt providers to offer PrEP unless otherwise contraindicated.
Kenneth H Mayer - One of the best experts on this subject based on the ideXlab platform.
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syphilis predicts hiv incidence among men and transgender women who have sex with men in a preexposure prophylaxis trial
Clinical Infectious Diseases, 2014Co-Authors: Marc M Solomon, Kenneth H Mayer, David V Glidden, Albert Y Liu, Vanessa Mcmahan, Juan V Guanira, Suwat Chariyalertsak, Telmo Fernandez, Robert M GrantAbstract:Background. Syphilis infection may potentiate transmission of human immunodeficiency virus (HIV). We sought to determine the extent to which HIV acquisition was associated with syphilis infection within an HIV preexposure prophylaxis (PrEP) trial and whether emtricitabine/tenofovir (FTC/TDF) modified that association. Methods. The Preexposure Prophylaxis Initiative (iPrEx) study randomly assigned 2499 HIV-seronegative men and transgender women who have sex with men (MSM) to receive oral daily FTC/TDF or placebo. Syphilis prevalence at screening and incidence during follow-up were measured. Hazard ratios for the effect of incident syphilis on HIV acquisition were calculated. The effect of FTC/TDF on incident syphilis and HIV acquisition was assessed. Results. Of 2499 individuals, 360 (14.4%) had a positive rapid plasma Reagin Test at screening; 333 (92.5%) had a positive confirmatory Test, which did not differ between the arms (FTC/TDF vs placebo, P= .81). The overall syphilis incidence during the trial was 7.3 cases per 100 person-years. There was no difference in syphilis incidence between the study arms (7.8 cases per 100 person-years for FTC/TDF vs 6.8 cases per 100 person-years for placebo, P= .304). HIV incidence varied by incident syphilis (2.8 cases per 100 person-years for no syphilis vs 8.0 cases per 100 personyears for incident syphilis), reflecting a hazard ratio of 2.6 (95% confidence interval, 1.6–4.4; P< .001). There was no evidence for interaction between randomization to the FTC/TDF arm and incident syphilis on HIV incidence. Conclusions. In HIV-seronegative MSM, syphilis infection was associated with HIV acquisition in this PrEP trial; a syphilis diagnosis should prompt providers to offer PrEP unless otherwise contraindicated.
Stephen Gloyd - One of the best experts on this subject based on the ideXlab platform.
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comparison of the diagnostic accuracy of a rapid immunochromatographic Test and the rapid plasma Reagin Test for antenatal syphilis screening in mozambique
Bulletin of The World Health Organization, 2006Co-Authors: Pablo Montoya, Sheila A Lukehart, Paula E Brentlinger, Ana Judith Blanco, Florencia Floriano, Josefa Sairosse, Stephen GloydAbstract:OBJECTIVE: Programmes to control syphilis in developing countries are hampered by a lack of laboratory services, delayed diagnosis, and doubts about current screening methods. We aimed to compare the diagnostic accuracy of an immunochromatographic strip (ICS) Test and the rapid plasma Reagin (RPR) Test with the combined gold standard (RPR, Treponema pallidum haemagglutination assay and direct immunofluorescence stain done at a reference laboratory) for the detection of syphilis in pregnancy. METHODS: We included Test results from 4789 women attending their first antenatal visit at one of six health facilities in Sofala Province, central Mozambique. We compared diagnostic accuracy (sensitivity, specificity, and positive and negative predictive values) of ICS and RPR done at the health facilities and ICS performed at the reference laboratory. We also made subgroup comparisons by human immunodeficiency virus (HIV) and malaria status. FINDINGS: For active syphilis, the sensitivity of the ICS was 95.3% at the reference laboratory, and 84.1% at the health facility. The sensitivity of the RPR at the health facility was 70.7%. Specificity and positive and negative predictive values showed a similar pattern. The ICS outperformed RPR in all comparisons (P<0.001). CONCLUSION: The diagnostic accuracy of the ICS compared favourably with that of the gold standard. The use of the ICS in Mozambique and similar settings may improve the diagnosis of syphilis in health facilities, both with and without laboratories.
Andrew L Corwin - One of the best experts on this subject based on the ideXlab platform.
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evaluation of rapid diagnostic Tests for the detection of human immunodeficiency virus types 1 and 2 hepatitis b surface antigen and syphilis in ho chi minh city vietnam
American Journal of Tropical Medicine and Hygiene, 2000Co-Authors: Truong Xuan Lien, R. Soderquist, K. Laras, Nguyen Thi Kim Tien, G F Chanpong, Andrew L CorwinAbstract:An evaluation of three new rapid diagnostic Test kits for human immunodeficiency virus types 1 and 2 (HIV-1/2), hepatitis B surface antigen (HBsAg), and syphilis involved a two-phase comparison of rapid diagnostic assays using prospectively collected from hospitals and clinics in Ho Chi Minh City, Vietnam. After specificity and sensitivity Testing, three new rapid diagnostic Test kits were Tested in parallel with six commonly used diagnostic Test kits. The DetermineHIV-1/2 Test had fewer indeterminate or equivocal results than the CapillusHIV-1/HIV-2 or HIV Blot 2.2� Tests. However, the DetermineHIV-1/2 Test yielded one false-positive result when compared with the SerodiaHIV, HIV Blot 2.2� , and microparticle enzyme immunoassay (IMx� ) HIV Tests. The SerodiaHBsAg Test yielded more false-negative results when compared with the DetermineHBsAg diagnostic Test kit. The results of the syphilis diagnostic Tests evaluated in this clinical trial consistently agreed with those of the rapid plasma Reagin Test for syphilis. The DetermineSyphilis Treponema pallidum (TP) Test had three false-positive results compared with the SerodiaTP and the SerodiaTP●particle agglutination (PA) Tests, which had two false-positive results that were confirmed as negative by an ELISA. Application of these serologic Tests within this comparative evaluation framework, using the World Health Organization alternative Testing strategies, proved to be an effective way to determine serostatus related to HIV, hepatitis B, and syphilis. In many developing areas worldwide, field and clinic lab- oratory capabilities may be insufficient for the detection of infectious agents for definitive clinical diagnostic purposes. The absence of simple, rapid diagnostic Testing methods for sexually transmitted diseases (STDs) and hepatitis has sig- nificantly hampered public health efforts to retard the spread of these diseases. The inability to provide Tests for quick recognition of human immunodeficiency virus (HIV), hep- atitis B, and syphilis has allowed infected individuals to un- knowingly spread the disease through sexual contacts, blood donations, and intravenous needle sharing. In cities through- out Asia, current laboratory evaluation of blood specimens may preclude case follow-up and counseling due to a long time lag between initial sample collection and conventional Test completion. High-risk populations typically seek treat- ment during clinic visits in association with acute episodes and are not likely to return a second time for Test results. Diagnostic technology is adapting itself for application in developing countries. Advancements in the laboratory di- agnosis of HIV/acquired immunodeficiency syndrome (AIDS), hepatitis B, and syphilis have considered the fol- lowing conditions, including: 1) speed of results; 2) Test va- lidity and accuracy; 3) minimal specimen requirement; 4) variable type of specimen, including whole blood; 5) ease of Test kit use, with few requirements for specialized labo- ratory equipment; and 6) stable reagents, requiring no re- frigeration. These criteria for the nine diagnostic Tests eval- uated are listed in Tables 1, 2, and 3.
