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Since the 1970s in Korea, consistent with the global tendency, there has been a fast decrease in favorable rates for syphilis. In 2000, 0.2% of the general Korean population was estimated to be syphilis-positive; since that time, levels appear to have decreased, and the prevalence rate is still quite low. 1 Despite these low rates, syphilis is an important infection as it can cause serious health concerns including neurosyphilis and congenital infection. Suitable evidence, screening and follow-up protocols are needed. Std Test near Baltimore MD United States. 2-4 Serological evaluation of non-treponemal reagin tests, such as the Venereal Disease Research Laboratory (VDRL), rapid plasma reagin (RPR) and treponemal tests including the Treponema pallidum haemagglutination assay (TPHA), the Treponema pallidum particle agglutination (TPPA) evaluation, the fluorescent treponemal antibody absorption test, and the Treponema-specific antibody test, have been utilized to diagnose and monitor syphilis diseases. Lately, there have been problems regarding selection of the best algorithm for first screening and follow-up by either non-treponemal- or treponemal-specific tests. 2 5 6 The Centers for Disease Control and Prevention (CDC) still advocate that a non-treponemal reagin test is used as the first-line diagnostic strategy. 2 Two kinds of non-treponemal test have been extensively used: RPR and VDRL. RPR is the most common first-line non-treponemal test used to screen for syphilis disease. Baltimore Maryland std test. 7 Lately, automated RPR evaluations are introduced, when the automated evaluation was compared with conventional RPR card tests, but variable results were reported. 8 The automated RPR test has some advantages over the standard RPR card test, like greater capacity to take care of a lot of samples, minimal person-to-person variation, and simple automated procedures.

All sera testing positive for syphilis by one or more tests from November 2012 to April 2013 from a university hospital were included, together with matched controls. Remnant sera from requested treponemal tests after evidence were included and preserved at 70C until analysis. Patients weren't categorised according to syphilis period because of the infrequency of syphilis infection. Cases of authentic syphilis were quite rare because of the low prevalence of syphilis in this country. The purpose of the study was to assess the same RPR evaluations with secure remnant specimens that are ethically. The institutional review board exempted this case. All study processes complied with the World Medical Association Declaration of Helsinki.

HiSens Auto RPR LTIA (HBI, Anyang, Korea) is a latex turbidimetric immunoassay using latex particles coated with lecithin and cardiolipin. The latex particles react with the reagin in the serum of patients with syphilis. The 15 L serum samples were allowed to react with 120 L Hisens auto RPR LTIA R1 (buffer) and 60 L Hisens auto RPR LTIA R2 (latex reagent containing cardiolipin-lecithin-cholesterol, 1.0 mg/mL) in a CA-400 autoanalyzer (Furuno Electric Co, Nishinomiya, Japan). The CA 400 photometric analyser was used for evaluation and the automated procedure. Absorbance at 600 nm was read after 5.3 and 10 s at room temperature, in duplicate. Results of the HiSens vehicle RPR test equal to or greater than 1.0 RPR unit (RU) were considered to signal reactive RPR. The upper detection limit was 20 RU.

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The Serodia TPPA assay (Fujirebio, Tokyo, Japan) is based on agglutination of coloured gelatine particles which have been sensitised (coated) with T. pallidum (Nichols strain) antigen. For every specimen, a 100 L sample of diluent and 25 L test specimen were blended, and twofold serial dilutions were made with 25 L sample diluent. The sensitised particles were serially combined in the neighbouring wells using a plate mixer for 30 s. After 2 h of incubation at room temperature, the end result of the agglutination assay was read. The Serodia TPPA assay results were interpreted using the agglutination patterns of negative and positive controls.

The percent agreement ( coefcient) of the automated RPR test with the manual RPR card test was calculated. The overall sensitivity and specificity of every test were computed based on the TPPA results. values were used to categorise results as quite good (0.81-1.0), good (0.61-0.8), moderate (0.41-0.6), rational (0.21-0.4) or inferior (0-0.2). Std Test near Baltimore MD. 9 The McNemar test was used to compare seroconversion rates between the automated RPR test and the traditional manual RPR card test and was performed using SPSS Statistics V.20. A p value

There were 24 discrepant results (21.4%) between the two RPR evaluations, including 22 negative HBI HiSens Auto RPR LTIA test results that showed positive results on the BD Macro-Vue RPR card test. Of these 22 discrepant results, 20 were TPPA positive and 2 were TPPA-negative, while 2 cases were positive on the HBI HiSens Auto RPR LTIA test but negative on the BD Macro-Vue RPR card test. Both of these instances were negative on the TPPA evaluation. Baltimore Std Test. There were four results with disparities between both the RPR tests and the TPPA assay, which was due to conditions besides syphilis infection ( table 2 ). The strength of agreement between the automated RPR and manual RPR evaluations was 'reasonable' ( value 0.296, 59 TPPA-favorable results; value 0.293, 53 TPPA-negative results) according to the TPPA results ( table 3 ).

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Std test nearest Baltimore, Maryland. The overall sensitivity and specificity of the HBI HiSens Auto RPR LTIA test based on TPPA results were 52.5% (95% CI 39.1% to 65.7%) and 94.3% (95% CI 84.3% to 98.8%), respectively. The overall sensitivity and specificity of the BD Macro-Vue RPR card test were 86.4% (95% CI 75% to 93.9%) and 94.3% (95% CI 84.3% to 98.8%), respectively ( table 4 ). Automated RPR provided a higher seroconversion rate after syphilis treatment (43.5% (10/23)) than the normal RPR card test (4.3% (1/23)) (p=0.004) by the McNemar test. A detailed comparison of the treated syphilis cases is given in table 5

Recently an automated RPR test was established and has been used due to its convenience in clinical settings, although the manual RPR test has been used for decades. However, there was a need for thorough inspection along with a comparison of results of this new automated evaluation together with the standard manual RPR test in diagnostic strategies. Treponemal test results don't change after treatment, as well as the patients dwell irrespective of treatment or disease activity with positive results for the rest of their lives. Treponemal tests cannot discriminate between previous infections, aggressive disease -treated patients. 10 In comparison, non-treponemal tests can discriminate between patients who have been treated during the primary or secondary phase of the disease. When the primary or secondary period of a first T. pallidum infection is treated, the non-treponemal test titre should show a twofold dilution fall after treatment, generally within 6 months. Std Test nearby MD. 7 Thus, the non-treponemal test is essential for handling syphilitic patients.

In our study, the conventional BD Macro-Vue RPR card test revealed better sensitivity in relation to the HBI HiSens Auto RPR LTIA test in syphilis screening, although the automated RPR test does have some advantages in the clinical setting. As an example, the automated RPR test reduced the workload and complete test turnaround time. It does not need evaluation pros and can also cope with greater test quantities in a given time compared to the RPR card test that is manual. Furthermore, we discovered the automated RPR test could be used as a tracking mark of treatment response, particularly if treponemal tests are used for first-line screening of syphilis as an inverse algorithm of syphilis testing. This inverse algorithm for syphilis testing has been proposed and adopted in several areas as it may be effective and more sensitive compared to the standard algorithm 3 4 6 in a low-prevalence area and can be automated. On the other hand, the CDC still recommend first screening for syphilis with a non-treponemal test like RPR. 2

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Our study found the automated RPR test showed earlier seroconversion in relation to the traditional card RPR test after syphilis treatment (p=0.004). If we embrace the reverse algorithm, treponemal tests can be used first to screen and then non-treponemal tests can be used to correctly show negative changes in treated cases. In this situation, we could use treponemal tests for first-line screening and non-treponemal tests for monitoring patients allowing us to observe seroconversion more efficiently after treatment. 2 13 14 Regrettably, our study had a limited variety of syphilitic patients due to the low prevalence of syphilis in our nation, or so the number of samples was small and could not been classified according to syphilis phase. In fact, in certain late or latent syphilis cases, the results of the non-treponemal test were difficult to interpret after first treatment in our study (cases 8 and 9 in table 5 ). So, further well-designed studies are needed according to the stage of syphilis disease and to clarify the serological results of automated RPR evaluations after treatment.

In clinical laboratories, automated RPR tests have lately been introduced in Korea, and assessments comparing conventional RPR tests and VDRL tests are reported. 8 15 Nonetheless, the results were varying. Onoe et al 16 also proposed that, when the automated serological testing system is used in clinical settings, the exact same reagent should be consistently selected to assess the changes in antibody titres, since the manual serological testing way of syphilis showed somewhat different consequences from the automated serological testing approaches. In this study, we noticed pretty consistent results between manual and automated RPR tests.

In conclusion, the automated RPR test demonstrated an entire lower sensitivity and similar specificity compared with the traditional manual RPR card test. Thus, we consider the automated RPR test is not suitable for use for first screening for syphilis. Nevertheless, it produces an earlier seroconversion reaction in treated cases than the normal RPR card test. Using the reverse algorithm, the sensitive treponemal test can be used as the first-line screening evaluation, and then the automated RPR test can be used as an adjunct to discover earlier seroconversion in treated patients.

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Results The percentage agreement between the two RPR evaluations was 78.6% ( 0.565; 95% CI 0.422 to 0.709). Sensitivity and specificity of the automated RPR test relative to the TPPA test was 52.5% (95% CI 39.1% to 65.7%) and 94.3% (95% CI 84.3% to 98.8%), respectively, while the same values for the normal RPR card test were 86.4% (95% CI 75% to 93.9%) and 94.3% (95% CI 84.3% to 98.8%), respectively. The conventional RPR card test demonstrated overall higher positivity in relation to the automated RPR test, while the automated RPR test revealed higher seroconversion (43.5%, 10/23) than the conventional RPR card test (4.3%, 1/23) in treated patients.

Since the 1970s in Korea, consistent with the international trend, there really has been a rapid decrease in favorable rates for syphilis. Std test closest to Baltimore. In 2000, 0.2% of the general Korean population was estimated to be syphilis-positive; since that time, amounts appear to have decreased, and the prevalence rate is still very low. 1 Despite these low rates, syphilis is an important disease since it can cause serious health problems including neurosyphilis and congenital infection. Suitable verification screening and follow up protocols are demanded. Std Test near Baltimore. 2-4 Serological analysis of non-treponemal reagin tests, like the Venereal Disease Research Laboratory (VDRL), rapid plasma reagin (RPR) and treponemal tests like the Treponema pallidum haemagglutination assay (TPHA), the Treponema pallidum particle agglutination (TPPA) test, the fluorescent treponemal antibody absorption test, and also the Treponema-specific antibody evaluation, have been employed to diagnose and track syphilis infections. Lately, there have been problems regarding choice of the best algorithm for initial screening and follow-up by either non-treponemal- or treponemal-specific evaluations. 2 , 5 , 6 The Centers for Disease Control and Prevention (CDC) still urge that a non-treponemal reagin test is used as the first-line diagnostic approach. 2 Two types of non-treponemal test have been extensively used: RPR and VDRL. RPR is the most common first-line non-treponemal test used to screen for syphilis infection. 7 Recently, automated RPR tests have been introduced, when the automated test was compared with normal RPR card evaluations but varying results were reported. 8 The automated RPR test has some advantages over the conventional RPR card test, for example greater ability to deal with a large number of samples, minimal person to person variation, and automated procedures that are straightforward.

All sera testing positive for syphilis by one or more tests from November 2012 to April 2013 from a university hospital were included, along with matched controls. Remnant sera from requested treponemal tests after verification were included and maintained at 70C until analysis. Patients were not categorised according to syphilis period because of the infrequency of syphilis disease. Instances of syphilis that is authentic were very rare because of the low prevalence of syphilis in this country. The goal of the study was to assess the same RPR evaluations with secure remnant specimens that are ethically. The institutional review board exempted this case. Std Test nearest Baltimore. All study processes complied with the World Medical Association Declaration of Helsinki. Std test in Baltimore MD.

HiSens Auto RPR LTIA (HBI, Anyang, Korea) is a latex turbidimetric immunoassay using latex particles coated with lecithin and cardiolipin. The latex particles react with the reagin in the serum of patients with syphilis. The 15 L serum samples were allowed to react with 120 L Hisens vehicle RPR LTIA R1 (buffer) and 60 L Hisens auto RPR LTIA R2 (latex reagent including cardiolipin-lecithin-cholesterol, 1.0 mg/mL) in a CA-400 autoanalyzer (Furuno Electric Co, Nishinomiya, Japan). The CA400 photometric analyser was used for the automated process and analysis. Absorbance at 600 nm was read after 5.3 and 10 s at room temperature, in duplicate. Results of the HiSens auto RPR test equal to or greater than 1.0 RPR unit (RU) were considered to signify reactive RPR. The upper detection limit was 20 RU.

Std test nearby Baltimore United States. The Serodia TPPA assay (Fujirebio, Tokyo, Japan) is based on agglutination of coloured gelatine particles that have been sensitised (coated) with T. pallidum (Nichols strain) antigen. For every specimen, a 100 L sample of 25 L test specimen and diluent were combined, and then twofold serial dilutions were made with 25 L sample diluent. The sensitised particles were serially blended in the neighbouring wells with a plate mixer for 30 s. After 2 h of incubation at room temperature, the consequence of the agglutination assay was read. The Serodia TPPA assay results were interpreted using the agglutination patterns of negative and positive controls.

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