title: On-site rapid antenatal syphilis screening with an immunochromatographic strip improves case detection and treatment in rural South African clinics.
abstract: OBJECTIVE
  Congenital syphilis is a significant cause of adverse pregnancy outcomes. In South Africa, rural clinics perform antenatal screening offsite, but unreliable transport and poor client follow up impede effective treatment. We compared 3 syphilis screening strategies at rural clinics: on-site rapid plasma reagin (RPR), on-site treponemal immunochromatographic strip (ICS) test, and the standard practice offsite RPR with Treponema pallidum hemagglutination assay (RPR/TPHA).
  
  
  METHODS
  Eight rural clinics performed the on-site RPR and ICS tests and provided immediate treatment. Results were compared with RPR/TPHA at a reference laboratory. Chart reviews at 8 standard practice clinics established diagnosis and treatment rates for offsite RPR/TPHA.
  
  
  RESULTS
  Seventy-nine (6.3%) of 1,250 women screened on-site had active syphilis according to the reference laboratory. The on-site ICS resulted in the highest percentage of pregnant women correctly diagnosed and treated for syphilis (89.4% ICS, 63.9% on-site RPR, 60.8% offsite RPR/TPHA). The on-site RPR had low sensitivity (71.4% for high-titer syphilis). The offsite approach suffered from poor client return rates. One percent of women screened with the ICS may have received penicillin unnecessarily. There were no adverse treatment outcomes.
  
  
  CONCLUSIONS
  The on-site ICS test can reduce syphilis-related adverse outcomes of pregnancy through accurate diagnosis and immediate treatment of pregnant women with syphilis.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA. RBronzan@msn.com
authors.forename: Rachel N
authors.initials: RN
authors.lastname: Bronzan
authors.forename: Dan C
authors.initials: DC
authors.lastname: Mwesigwa-Kayongo
authors.forename: Diane
authors.initials: D
authors.lastname: Narkunas
authors.forename: George P
authors.initials: GP
authors.lastname: Schmid
authors.forename: Graham A
authors.initials: GA
authors.lastname: Neilsen
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Ballard
authors.forename: Pascale
authors.initials: P
authors.lastname: Karuhije
authors.forename: James
authors.initials: J
authors.lastname: Ddamba
authors.forename: Eric
authors.initials: E
authors.lastname: Nombekela
authors.forename: Gideon
authors.initials: G
authors.lastname: Hoyi
authors.forename: Pumla
authors.initials: P
authors.lastname: Dlali
authors.forename: Nomalanga
authors.initials: N
authors.lastname: Makwedini
authors.forename: H Glenda
authors.initials: HG
authors.lastname: Fehler
authors.forename: John M
authors.initials: JM
authors.lastname: Blandford
authors.forename: Caroline
authors.initials: C
authors.lastname: Ryan
mesh_terms: D000293:Adolescent; D000328:Adult; D002845:Chromatography / Q000379:methods; D005260:Female; D006386:Hemagglutination Tests; D006801:Humans; D007118:Immunoassay; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008403:Mass Screening / Q000379:methods; D011237:Predictive Value of Tests; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D011296:Prenatal Diagnosis / Q000592:standards / Q000706:statistics & numerical data*; D011933:Reagent Kits, Diagnostic / Q000592:standards / Q000706:statistics & numerical data; D011935:Reagins / Q000097:blood; D019035:Rural Health Services / Q000592:standards; D012680:Sensitivity and Specificity; D013019:South Africa / Q000453:epidemiology; D013587:Syphilis / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000635:transmission; D013588:Syphilis Serodiagnosis / Q000191:economics; D013590:Syphilis, Congenital / Q000517:prevention & control*; D014210:Treponema pallidum / Q000276:immunology
chemical_list: D011933:Reagent Kits, Diagnostic; D011935:Reagins