-The rapid syphilis test: is it useful for syphilis diagnosis among HIV-vulnerable groups? The Argentinean experience

DURAN A; GALLO VAULET L; RODRIGUEZ FERMEPÍN M; CASCO R; ROSSI D; MARONE R; ORELLANO G; ROMERO M; PETRACCA C; BENEDETTI E; AVILA MM,; SALOMÓN H; PANDO MA

Vancouver

Congreso; 8th IAS Conference on HIV Pathogenesis, Treatment and Prevention; 2015

IAS

Abstract Preview - Step 3/4 - print version - Abstract category: B21 Syphilis Title: The rapid syphilis test: is it useful for syphilis diagnosis among HIV-vulnerable groups? The Argentinean experience. Authors: A. Duran 1 , L. Gallo Vaulet 2 , M. Rodriguez Fermepín 2 , R. Casco 3 , D. Rossi 4 , R. Marone 5 , G. Orellano 6 , M. Romero 7 , C. Petracca 8 , E. Benedetti 9 , M.M. Avila 10 , H. Salomón 10 , M.A. Pando 10 Institution(s): 1 Coordinacion SIDA, Ministerio de Salud, Buenos Aires, Argentina, 2 Laboratorio de Inmunología y Virología Clínica, Hospital de Clínicas ?José de San Martín?, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina, 3 Programa de Enfermedades de Transmisión Sexual (PETS), Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Buenos Aires, Argentina, 4 Intercambios AC, Buenos Aires, Argentina, 5 Nexo AC, Buenos Aires, Argentina, 6 Asociación de Mujeres Meretrices de Argentina (AMMAR), Buenos Aires, Argentina, 7 Asociación de Travestis Transexuales y Transgéneros de Argentina (ATTTA), Buenos Aires, Argentina, 8 Programa de VIH-sida e ITS, Municipalidad de San Martín, San Martín, Provincia de Buenos Aires, Argentina, 9 Hospital en Red Especializado en Salud Mental y Adicciones (ex CENARESO), Buenos Aires, Argentina, 10 Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Buenos Aires, Argentina Text: Background: In Argentina, syphilis, caused by infection with Treponema pallidum, subsp. pallidum, has been reported in high prevalence in HIV-vulnerable groups. A new syphilis-rapid test (RT) has recently been approved in the country. In order to evaluate this RT, it was included in the syphilis diagnoses algorithm during a cross sectional prevalence study among vulnerable groups. Methods: A cross-sectional syphilis and HIV prevalence study was conducted at different settings (non-governmental organizations, hospitals and field visits) (September 2013-May 2014). Men who have sex with men (MSM), female transgender/travesties, drug users (DU) and female sex workers (FSW) were included. Syphilis diagnosis was done using: Alere Determine Syphilis TP, VDRL, TPHA and FTA. HIV diagnosis was also done (Allere Determine HIV-1/2, Genscreen Ultra HIV Ag&Ab, bDNA Versant HIV RNA). Results: 1517 individuals were tested. Comparison of syphilis-RT with standard laboratory diagnosis showed that 53 samples non-reactive for syphilis-RT were positive for syphilis according to other laboratory tests. Among these, 16 had reactive TPHA, 5 had reactive VDRL/FTA and 31 had both. Seventeen samples that were reactive for syphilis-RT were confirmed as negative by standard laboratory. Sensitivity and specificity for syphilis RT was 81.3% and 98.8% respectively (PPV: 93.1%, NPV: 96.4%). Prevalence of syphilis was 17.7% (179/1014, 95% CI 15.2-20.0) for MSM, 47.3% (78/165, 95% CI 39.3-55.2) for transgender/travesties, 7.7% (20/259, 95% CI 4.3-11.2) for DU and 14.1% (11/78, 95% CI 5.7-22.5) for FSW. Co-infection with HIV was detected among 17,0% transgender/travesties, 4.2% MSM and 0.8% DU. In few patients clinical data were obtained: 78.2% (43/55) with reactive RT and 90% (10/11) with no-reactive RT (but reactive by laboratory assays) presented clinical manifestations that justified penicillin treatment. Conclusions: Early detection and treatment of syphilis is critical in preventing severe long-term complications, co-infection with agents like HIV and transmission to sexual partners. Syphilis-RT implementation could aid early diagnosis. Since treponemal RT cannot distinguish between active and past infection, treatment of all RT-positive individuals will result in over-treatment. However, given the high prevalence of infection in vulnerable groups and the serious consequences of missed treatment, the benefits of syphilis-RT implementation should be considered in some settings. Country of research: Argentina