title: Metaanalysis of the Performance of a Combined Treponemal and Nontreponemal Rapid Diagnostic Test for Syphilis and Yaws.
abstract: BACKGROUND
  The human treponematoses are important causes of disease. Mother-to-child transmission of syphilis remains a major cause of stillbirth and neonatal death. There are also almost 100 000 cases of endemic treponemal disease reported annually, predominantly yaws. Rapid diagnostic tests (RDTs) would improve access to screening for these diseases. Most RDTs cannot distinguish current and previous infection. The Dual Path Platform (DPP) Syphilis Screen & Confirm test includes both a treponemal (T1) and nontreponemal (T2) component and may improve the accuracy of diagnosis.
  
  
  METHODS
  We conducted a metaanalysis of published and unpublished evaluations of the DPP-RDT for the diagnosis of syphilis and yaws. We calculated the sensitivity, specificity, and overall agreement of the test compared with reference laboratory tests.
  
  
  RESULTS
  Nine evaluations, including 7267 tests, were included. Sensitivity was higher in patients with higher titer rapid plasma reagin (≥1:16) for both the T1 (98.2% vs 90.1%, P < .0001) and the T2 component (98.2% vs 80.6%, P < .0001). Overall agreement between the DPP test and reference serology was 85.2% (84.4%-86.1%). Agreement was highest for high-titer active infection and lowest for past infection.
  
  
  CONCLUSIONS
  The RDT has good sensitivity and specificity of the treponemal and nontreponemal components both in cases of suspected syphilis and yaws, although the sensitivity is decreased at lower antibody titers.
authors.affiliation: Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine.|Hospital for Tropical Diseases, University College London Hospitals NHS Trust, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Marks
authors.affiliation: National Center for STD Control, China Center for Disease Control and Prevention, Beijing.|Chinese Academy of Medical Sciences Institute of Dermatology and Hospital of Skin Diseases, Nanjing, China.
authors.forename: Yue-Ping
authors.initials: YP
authors.lastname: Yin
authors.affiliation: National Center for STD Control, China Center for Disease Control and Prevention, Beijing.|Chinese Academy of Medical Sciences Institute of Dermatology and Hospital of Skin Diseases, Nanjing, China.
authors.forename: Xiang-Sheng
authors.initials: XS
authors.lastname: Chen
authors.affiliation: Laboratory Reference & Research Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Arnold
authors.initials: A
authors.lastname: Castro
authors.affiliation: Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Causer
authors.affiliation: Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Guy
authors.affiliation: Papua New Guinea Institute of Medical Research, Goroka, Eastern Highland Province.
authors.forename: Regina
authors.initials: R
authors.lastname: Wangnapi
authors.affiliation: Barcelona Institute for Global Health, Barcelona Centre for International Health Research, Hospital Clinic, University of Barcelona, Spain.|Lihir Medical Centre, International SOS, Newcrest Mining, Lihir Island, Papua New Guinea.
authors.forename: Oriol
authors.initials: O
authors.lastname: Mitjà
authors.affiliation: Ghana Health Services, Accra.
authors.forename: Abdul
authors.initials: A
authors.lastname: Aziz
authors.affiliation: Unidade de Microbiologica Médica, Instituto de Higiene e Medicina Tropical, Lisbon, Portugal.
authors.forename: Rita
authors.initials: R
authors.lastname: Castro
authors.affiliation: Unidade de Microbiologica Médica, Instituto de Higiene e Medicina Tropical, Lisbon, Portugal.
authors.forename: Filomena
authors.initials: F
authors.lastname: da Luz Martins Pereira
authors.affiliation: Ministry of Health, Port Vila, Vanuatu.
authors.forename: Fasihah
authors.initials: F
authors.lastname: Taleo
authors.affiliation: Laboratoire de Microbiologie, Centre Hospitalier Régional d'Orléans.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Guinard
authors.affiliation: Laboratoire de Microbiologie, hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris.|Faculté de Médecine Paris Descartes, Université Paris Descartes (Paris V), Sorbonne Paris Cité, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Bélec
authors.affiliation: Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Ye
authors.initials: Y
authors.lastname: Tun
authors.affiliation: Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom.
authors.forename: Christian
authors.initials: C
authors.lastname: Bottomley
authors.affiliation: Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Ballard
authors.affiliation: Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine.|Hospital for Tropical Diseases, University College London Hospitals NHS Trust, United Kingdom.
authors.forename: David C W
authors.initials: DCW
authors.lastname: Mabey
mesh_terms: D006801:Humans; D015233:Models, Statistical; D000067716:Point-of-Care Testing; D011933:Reagent Kits, Diagnostic; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013587:Syphilis / Q000175:diagnosis*; D015001:Yaws / Q000175:diagnosis*
chemical_list: D011933:Reagent Kits, Diagnostic
keywords: metaanalysis; point-of-care test; sexually transmitted infections; syphilis; yaws