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Utility of rapid plasmin reagin titres in assessing treatment response and re-infection for infectious syphilis.

Abstract：

:Background The rapid plasma reagin (RPR) assay is commonly used as a surrogate marker of infectious syphilis, but is non-specific, slow to change and variable in its rate of decline post treatment. METHODS:Within an urban sexual health service testing predominantly men who have sex with men, a file review of RPR changes was undertaken in all subjects who had a dilution level of ≥1:4, between January 2015 to the end of December 2018. RESULTS:Overall, 248 cases of infectious syphilis were identified in 215 subjects (165 HIV seropositive, 50 HIV seronegative). Among unique-subject cases with follow-up RPR recorded, seroreversion to a non-reactive titre was achieved in only 42.3% (71/168) cases at a median of 235 days (interquartile range: 138-348 days) and was significantly less likely if patients had HIV infection (P = 0.02), late latent syphilis (P = 0.003) or a subsequent syphilis infection (P < 0.0001). Having HIV infection (P = 0.03) or a subsequent episode of syphilis (P = 0.01) were associated with a lower likelihood of documented cure. CONCLUSIONS:The slow decay in RPR titres post therapy and the inability of a significant number of subjects to achieve a non-reactive result over time makes RPR a poor test for assessing the adequacy of treatment or in diagnosing re-infection, especially in populations having repeated and frequent risk exposures. As the number of syphilis cases continue to climb, better tests that accurately assess pathogen presence are urgently needed.

journal_name

Sex Health

journal_title

Sexual health

authors

Harjanto R,Smith DE,Barratt H,Kelly M,Chan D,Furner V,Smith M,Ronnachit A,Post J,Rawlinson W

doi

10.1071/SH20043

subject

Has Abstract

pub_date

2020-08-01 00:00:00

pages

330-336

issue

4

eissn

1448-5028

issn

1449-8987

pii

SH20043

journal_volume

17

pub_type

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