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Poster Session I: STI Diagnostics

(P99) PERFORMANCE OF SYPHILIS TREPONEMAL AND NONTREPONEMAL SEROLOGIC TESTS IN SPECIMENS FROM PREGNANT WOMEN: A REVIEW AND META-ANALYSIS

Tuesday, September 17, 2024
4:15 PM - 5:15 PM EST

    Primary Author(s)

  • Jessica Perez (she/her/hers)

    Medical Student
    Department of Population and Public Health Sciences, University of Southern California
    Norwalk, California, United States

    • Co-Author(s)(s)

  • Chibuzor M. Babalola, MD, MPH

    Postdoctoral Research Associate & Part-time Professor
    Keck School of Medicine Department of Population and Public Health Sciences, University of Southern California, United States

  • CW

    Choo Phei Wee, MS

    Southern California Clinical and Translational Science Institute

  • Jeffrey D. Klausner, MD (he/him/his)

    Clinical Professor
    Department of Population and Public Health Sciences, University of Southern California
    Los Angeles, California, United States

Background:
Congenital syphilis continues to surge in the US, emphasizing the need for prompt screening and treatment during pregnancy. To inform assessments of emerging point-of-care tests for maternal syphilis screening, clarifying the diagnostic accuracy of existing laboratory tests is crucial. Our review aimed to evaluate the sensitivity and specificity of currently approved treponemal/nontreponemal serologic tests.

Methods:
We searched PubMed, Embase, and Cochrane Library to February 2022 for diagnostic accuracy studies of serologic tests for syphilis in pregnant women. Methodological quality of studies was assessed using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies). A bivariate meta-analysis was completed to generate pooled estimates of sensitivity and specificity in treponemal and nontreponemal tests, and forest plots were used to evaluate heterogeneity of these diagnostic parameter estimates.

Results:
From over 5000 abstracts and 78 full texts screened, only 10 studies included pregnant women, evaluating 11 treponemal assays (N=4143) and 2 nontreponemal assays (N=9383). Our sensitivity analysis incorporated six studies with sufficient data, yielding a pooled sensitivity estimate of 0.81 (95%CI = 0.56 to 1.05) for treponemal tests and 0.90 (95%CI = 0.87 to 0.93) for nontreponemal tests. Specificity analysis incorporated data from eight studies, resulting in pooled estimates of 0.99 (95%CI = 0.98 to 1.00) for treponemal tests and 1.00 (95%CI = 1.00 to 1.00) for nontreponemal tests. Subgroup analyses revealed low heterogeneity between treponemal and nontreponemal tests.

Conclusion:
Despite the limited number of eligible studies, the high specificity observed in both treponemal and nontreponemal tests in our analysis should give clinicians confidence in positive test results. However, the moderate sensitivity underscores the importance of adhering to current recommendations for repeat screening. Overall, more studies are needed in pregnant women, employing newer assays and rapid point of care tests.