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Evaluating congenital syphilis in a reverse sequence testing environment

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Abstract

Objectives

To examine the effect of maternal reverse-sequence (RS) syphilis screening on management of infants at risk for congenital syphilis (CS) using a standardized approach.

Study design

 A retrospective study from 2011 to 2014 at an academic medical center using RS testing, involving chemiluminescent immunoassay (CIA), rapid plasma  reagin (RPR), and fluorescent treponemal antibody-absorption (FTA-ABS) assays for syphilis. Clinical management and outcomes of infants born to mothers with discordant (CIA+/RPR−/FTA+) serology were compared with national or internal guidelines.

Results

Sixty-three infants were classified as discordant (n = 21), presumed false positive (CIA+/RPR−/FTA−; n = 16), or true positive (CIA+/RPR+; n = 26) based on maternal serology. Only 24% of cases in the discordant group underwent recommended full evaluation. None of the evaluated infants in the discordant group (n = 8) were diagnosed with CS.

Conclusions

Management of infants with discordant maternal RS serology remained reliant on clinical judgment. In our high-risk population, RS testing did not identify additional cases of CS.

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Acknowledgements

The authors would like to thank Pablo J. Sanchez, MD (Division of Neonatology, Ohio State University College of Medicine, Columbus, Ohio) for his advice during initial generation of the internal algorithm. They also thank Pranita D. Tamma, MD, MHS and Alice J. Hsu, Pharm. D. (Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine) for updating our algorithm and for providing additional recommendations for evaluation and management. Finally, they thank Jeanne S. Sheffield, MD (Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine) for advice in revising this paper.

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Author notes

  1. Ibukunoluwa C. Akinboyo

    Present address: Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA

  2. Paul K. Sue

    Present address: Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA

  3. Ravit Arav-Boger

    Present address: Division of Pediatric Infectious Diseases, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA

Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA

    May W. Chen, Pamela K. Donohue & W. Christopher Golden

  2. Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Ibukunoluwa C. Akinboyo, Paul K. Sue & Ravit Arav-Boger

  3. Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Khalil G. Ghanem & Kathleen R. Page

  4. Division of Immunopathology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Barbara Detrick

  5. Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Frank R. Witter

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  1. May W. Chen
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Corresponding author

Correspondence to W. Christopher Golden.

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Chen, M.W., Akinboyo, I.C., Sue, P.K. et al. Evaluating congenital syphilis in a reverse sequence testing environment. J Perinatol 39, 956–963 (2019). https://doi.org/10.1038/s41372-019-0387-9

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