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Shukla M, Pereira L, Sun Y, Fakile YF, Kersh EN, Cao W. Considerations for Endpoint Titer Determination in Syphilis Testing Using Newly Marketed, Automated Rapid Plasma Reagin Instruments. Public Health Rep 2024; 139:169-173. [PMID: 37243528 PMCID: PMC10851900 DOI: 10.1177/00333549231176007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Affiliation(s)
- Mayur Shukla
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lara Pereira
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yongcheng Sun
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yetunde F. Fakile
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ellen N. Kersh
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Weiping Cao
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Papp JR, Park IU, Fakile Y, Pereira L, Pillay A, Bolan GA. CDC Laboratory Recommendations for Syphilis Testing, United States, 2024. MMWR Recomm Rep 2024; 73:1-32. [PMID: 38319847 PMCID: PMC10849099 DOI: 10.15585/mmwr.rr7301a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
This report provides new CDC recommendations for tests that can support a diagnosis of syphilis, including serologic testing and methods for the identification of the causative agent Treponema pallidum. These comprehensive recommendations are the first published by CDC on laboratory testing for syphilis, which has traditionally been based on serologic algorithms to detect a humoral immune response to T. pallidum. These tests can be divided into nontreponemal and treponemal tests depending on whether they detect antibodies that are broadly reactive to lipoidal antigens shared by both host and T. pallidum or antibodies specific to T. pallidum, respectively. Both types of tests must be used in conjunction to help distinguish between an untreated infection or a past infection that has been successfully treated. Newer serologic tests allow for laboratory automation but must be used in an algorithm, which also can involve older manual serologic tests. Direct detection of T. pallidum continues to evolve from microscopic examination of material from lesions for visualization of T. pallidum to molecular detection of the organism. Limited point-of-care tests for syphilis are available in the United States; increased availability of point-of-care tests that are sensitive and specific could facilitate expansion of screening programs and reduce the time from test result to treatment. These recommendations are intended for use by clinical laboratory directors, laboratory staff, clinicians, and disease control personnel who must choose among the multiple available testing methods, establish standard operating procedures for collecting and processing specimens, interpret test results for laboratory reporting, and counsel and treat patients. Future revisions to these recommendations will be based on new research or technologic advancements for syphilis clinical laboratory science.
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Gottlieb M, Williams CJ, Pierre VA. What Is the Accuracy of Vaginal Swab Versus Urine for Detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis? Ann Emerg Med 2023; 82:517-519. [PMID: 37598331 DOI: 10.1016/j.annemergmed.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Cody J Williams
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Valerie A Pierre
- Department of Emergency Medicine, University of Maryland, Baltimore, MD
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Chi KH, de Voux A, Morris M, Katz SS, Pillay A, Danavall D, Bowden KE, Gaynor AM, Kersh EN. Detection of Lymphogranuloma Venereum-Associated Chlamydia trachomatis L2 Serovars in Remnant Rectal Specimens Collected from 7 US Public Health Laboratories. Sex Transm Dis 2022; 49:e26-e28. [PMID: 34075001 PMCID: PMC8663523 DOI: 10.1097/olq.0000000000001483] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT The frequency of lymphogranuloma venereum or invasive Chlamydia trachomatis infection with serovar L1, L2, or L3 is unknown in the United States. While no diagnostic test is commercially available, we used a laboratory-developed test and detected lymphogranuloma venereum-associated serovar L2 in 14% of 132 remnant C. trachomatis-positive rectal swabs.
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Affiliation(s)
- Kai H. Chi
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Alex de Voux
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Monica Morris
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Samantha S. Katz
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Allan Pillay
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Damien Danavall
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Katherine E. Bowden
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Anne M. Gaynor
- Association of Public Health Laboratories, Silver Spring, MD
| | - Ellen N. Kersh
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
- Association of Public Health Laboratories, Silver Spring, MD
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Hook EW. The Need for New Tools for Syphilis Diagnosis and Management. Clin Infect Dis 2021; 73:e3259-e3260. [PMID: 33188388 DOI: 10.1093/cid/ciaa1724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Edward W Hook
- Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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At-home Specimen Self-Collection and Self-Testing for STI Screening Demand Accelerated by the COVID-19 Pandemic - A Review of Laboratory Implementation Issues. J Clin Microbiol 2021; 59:e0264620. [PMID: 34076475 DOI: 10.1128/jcm.02646-20] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The idea of specimen self-collection or self-STI testing is not new. In 2019, the World Health Organization (WHO) published the "WHO Consolidated Guideline on Self-Care Interventions for Health" as a first installment in a planned series for various diseases (8). The first document focused on "Sexual and Reproductive Health and Rights". Self-care including self-testing has the readily apparent benefits of privacy, confidentiality, speed, convenience, and access if the price is affordable. It is "people-centered" (9) and enables active participation in one's own health. It is also a health system approach as it can reduce burden on stretched systems with world-wide shortages in medical personnel or other barriers to health care access. Potential risks include: low specimen return rates, uncertain follow-up (linkage to care including treatment, repeat testing including test of cure, partner notification, counseling on risk reduction), unintended/unnecessary use (resulting in false positives with their own set of associated problems), incorrect use, lack of understanding of window periods (resulting in false negatives), lack of surveillance data generation, among other issues (9). The WHO systematically reviewed evidence for self-testing or specimen self-collection for GC, CT and syphilis, including US studies, and published a meta-analysis of available evidence (9). Programs offering self-collection of samples increased overall uptake of STI testing services (RR: 2.941, 95% CI 1.188 to 7.281) and case finding (RR: 2.166, 95% CI1.043 to 4.498), prior to the pandemic (9). U. S. laboratory research on the equivalence and/or superiority of self-collected versus provider-collected specimens for test sensitivity was reported by Gaydos et al (summarized or referenced in (10)). Based on this evidence, WHO issued a new recommendation in 2019 "Self-collection of samples for Neisseria gonorrhoeae and Chlamydia trachomatis should be made available as an additional approach to deliver STI testing services for individuals using STI testing services" (8). In addition, WHO issued a new and conditional recommendation: "Self-collection of samples for Treponema pallidum (syphilis) and Trichomonas vaginalis may be considered as an additional approach to deliver STI testing services for Individuals using STI testing services" (8). Thus, even before the COVID-19 pandemic, substantial expert agreement existed concerning benefits of this approach.
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Davis A, Gaynor A. A Comparison of US Clinical Laboratory Chlamydia and Gonorrhea Testing Practices Before and After the 2014 Centers for Disease Control and Prevention Testing Recommendations. Sex Transm Dis 2021; 48:e73-e76. [PMID: 32956240 PMCID: PMC7969476 DOI: 10.1097/olq.0000000000001299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/13/2020] [Indexed: 12/04/2022]
Abstract
BACKGROUND Adherence to recommended laboratory testing practices is crucial for sexually transmitted infection prevention and control. The objective of this article is to compare Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing practices of US clinical laboratories in 2013 before the updated 2014 Centers for Disease Control and Prevention recommendations and in 2015 after the updated recommendations. METHODS A total of 236 clinical laboratories participated in surveys about their 2013 and 2015 CT and NG testing practices, including questions on specimen types collected and assays used. RESULTS There was an increase of 5 laboratories offering CT nucleic acid amplification testing (NAAT) from 2013 to 2015 and an increase of 5 laboratories offering NG NAAT. There was a net increase of 3 laboratories accepting urine for CT and NG NAAT, the preferred specimen type for male individuals. There was not a net increase in the total number of laboratories accepting vaginal swabs for CT NAAT (n = 89 in 2013 and 2015), the preferred specimen type for female individuals, but there was an increase of 3 laboratories accepting vaginal swabs for NG NAAT. The number of laboratories performing NG susceptibility testing decreased from 100 in 2013 to 89 in 2015 (χ2 = 1.07, P > 0.10). CONCLUSIONS There were no major changes in testing practices in the 2-year period from 2013 to 2015. However, there were some small shifts, including increases in the use of NAATs, acceptance of Centers for Disease Control and Prevention-preferred specimen types for CT/NG, and changes in usage of assays by manufacturer.
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Affiliation(s)
- Alissa Davis
- From the Columbia University School of Social Work, New York, NY
| | - Anne Gaynor
- Association of Public Health Laboratories, Silver Spring, MD
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Kumar S, Chesson H, Gift TL. Estimating the Direct Medical Outpatient Costs of Diagnosis and Treatment of Trichomoniasis Among Commercially Insured Patients in the United States, 2016 to 2018. Sex Transm Dis 2021; 48:e45-e47. [PMID: 32810026 PMCID: PMC9425440 DOI: 10.1097/olq.0000000000001266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT We used 2016-2018 outpatient claims data to calculate direct outpatient medical costs per case of trichomoniasis in 2019 US dollars. The outpatient, drug, and total costs per treated case of trichomoniasis were $174, $39, and $213, respectively. Total costs were higher for female patients ($220) than for male patients ($158).
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Affiliation(s)
- Sagar Kumar
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA
- Oak Ridge Institute of Science and Education, Oak Ridge, TN
| | - Harrell Chesson
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA
| | - Thomas L. Gift
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA
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Public Health Laboratories: An Important Ally in Sexually Transmitted Infection Control. Sex Transm Dis 2019; 47:128-129. [PMID: 31860553 DOI: 10.1097/olq.0000000000001118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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