infectious diseases
Syphilis Rising: APHL’ s Efforts to Address Another Historic Foe
by Anne M. Gaynor, PhD, manager, HIV, Hepatitis, STDs
evaluate new assays.
The North Carolina State Public Health Laboratory conducted an evaluation of the FDA-cleared rapid syphilis test, examining its performance in the state laboratory and two county STD clinics. APHL, CDC and North Carolina have been working to get this data published in a peerreviewed journal, while APHL continues to work with CDC to identify new syphilis diagnostics tests that can or should be evaluated in partnership with member laboratories.
Treponema pallidum spirochetes highlighted using a modified Steiner silver stain. Photo: CDC Public Health Image Library
2018 has provided a useful reminder of the importance of not only remembering our past but learning from it as well. While we commemorate the 100th anniversary of the 1918 influenza pandemic, let us not forget about some of our other microbial foes. Syphilis, a sexually transmitted infection caused by the Treponema pallidum bacteria, is 100 % preventable and curable. Even so it has caused illness and death for hundreds of years.
Unlike our constantly changing influenza viruses, Treponema pallidum has not changed since we named it. The current treatment— used since the 1940s— is penicillin, and while new tests have been developed to detect the pathogen, we still rely heavily on those created in the 1950s.
With such a history, it may be hard to believe that syphilis is not a disease of a bygone era but a very real issue facing us today. Rates of syphilis are the highest in more than 20 years, with a 67 % increase between 2011 and 2015 and increased cases of transmission from mother to child during pregnancy resulting in severe morbidity and mortality.
In April 2017, the US Centers for Disease Control and Prevention( CDC) published their syphilis call to action and outlined steps that various sectors can take to meet their collective goals. The first is to create new tools to detect and treat syphilis, a goal that APHL and its members have pursued even before this official call.
Since 2013, 14 APHL member laboratories have submitted over 600 residual syphilis positive specimens to CDC for inclusion in their specimen repository. APHL will once again request samples in 2018. Additionally, APHL has worked with CDC to make these samples available, through an online request to CDC, to diagnostic manufacturers that need samples to
APHL has been helping to develop laboratory guidelines for diagnosis of Treponema pallidum for many years. In 2009, APHL hosted a meeting to review the literature at that time( in conjunction with the meeting to develop the Neisseria gonorrhea and Chlamydia trachomatis laboratory guidelines). Unfortunately, the meeting did not result in the development of laboratory guidelines. Noting the lack of formal recommendations and the need for improved understanding and guidance, the APHL STD Subcommittee got to work. In 2015-2016 they developed three online training modules for syphilis serology testing and developed the publication, Suggested Reporting Language for Syphilis Serology Testing. In early 2017, APHL partnered with CDC’ s Division of Sexually Transmitted Disease Prevention to evaluate the literature and identify best practices for laboratory diagnosis of syphilis in the US. A structured external review process was established culminating in a two-day consultation November 28-29, 2017. APHL is in the process of finalizing the draft meeting report from the consultation, which will be published on aphl. org. n
30 LAB MATTERS Spring 2018
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