Lab Matters Spring 2018 | Page 32

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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