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Performance of treponemal tests for the diagnosis of syphilis
  • Published Date:
    Mar 05 2019
  • Source:
    Clin Infect Dis. 68(6):913-918
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Public Access Version Available on: March 05, 2020 information icon
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  • Description:

    Treponemal immunoassays are increasingly used for syphilis screening with the reverse sequence algorithm. There are little data describing performance of treponemal immunoassays compared to traditional treponemal tests in patients with and without syphilis.


    We calculated sensitivity and specificity of seven treponemal assays: 1) ADVIA Centaur (chemiluminescence immunoassay-CIA), 2) Bioplex 2200 (microbead immunoassay-MBIA), 3) fluorescent treponemal antibody absorbed test (FTA-ABS), 4) INNO-LIA (line immunoassay), 5) LIAISON CIA, 6) TP-PA (Treponema pallidum particle agglutination assay), and 7) Trep-Sure (enzyme immunoassay-EIA), using a reference standard combining clinical diagnosis and serology results. Sera were collected between May 2012 to January 2013. Cases were characterized as: 1) current clinical diagnosis of syphilis: primary, secondary, early latent, late latent 2) prior treated syphilis only, 3) no evidence of current syphilis, no prior history of syphilis and at least 4/7 treponemal tests negative.


    Among 959 participants, 262 had current syphilis, 294 had prior syphilis, and 403 did not have syphilis. FTA-ABS was significantly less sensitive for primary syphilis [78.2% (65.0–88.2)], compared to the immunoassays or TP-PA (94.5–96.4%) (all p≤0.01). All immunoassays were 100% sensitive for secondary syphilis and 95.2–100% sensitive for early latent disease, but were less sensitive in late latent disease (86.8–98.5%). TP-PA had 100% specificity (99.0–100).


    Treponemal immunoassays demonstrated excellent sensitivity for early syphilis. Sensitivity of FTA-ABS in primary syphilis was poor compared to the immunoassays and TP-PA. Given its high specificity and superior sensitivity, TP-PA is a better test to adjudicate discordant results with the reverse sequence algorithm than the FTA-ABS.

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