{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T19:09:56Z","timestamp":1779908996518,"version":"3.53.1"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T00:00:00Z","timestamp":1715212800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIH","award":["5R01HD094650-02"],"award-info":[{"award-number":["5R01HD094650-02"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>There have been few empirical studies for diagnostic test accuracy of syphilis using a sequence of rapid tests in populations with low prevalence of syphilis such as pregnant women. This analysis describes syphilis test positivity frequency among pregnant women at an antenatal clinic in Zambia using a reverse-sequence testing algorithm for antenatal syphilis screening.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Between August 2019 and May 2023, we recruited 1510 pregnant women from a peri-urban hospital in Lusaka, Zambia. HIV positive and HIV negative women were enrolled in a 1:1 ratio. Blood collected at recruitment from the pregnant mothers was tested on-site for syphilis using a rapid treponemal test. Samples that tested positive were further tested at a different laboratory, with rapid plasma reagin using archived plasma.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of the total 1,421 sera samples which were screened with a rapid treponemal test, 127 (8.9%) were positive and 1,294 (91.1%) were negative. Sufficient additional samples were available to perform RPR testing on 114 of the 127 (89.8%) RDT positive specimens. Thirty-one (27.2%) of these 114 were reactive by RPR and 83 (72.8%) were negative, resulting in a syphilis overtreatment rate of 3 fold (i.e, 84\/114). Insufficient sample or test kit availability prevented any testing for the remaining 89 (5.9%) participants.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Use of only treponemal tests in low prevalence populations, like pregnant women, subjects individuals with non-active syphilis to the costs and possible risks of overtreatment. The use of the dual treponemal and non-treponemal tests would minimize this risk at some additional cost.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0303253","type":"journal-article","created":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T17:54:45Z","timestamp":1715277285000},"page":"e0303253","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Single-test syphilis serology: A case of not seeing the forest for the trees"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8491-7346","authenticated-orcid":true,"given":"Ethan Mabvuto","family":"Zulu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie M.","family":"Herlihy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassandra R.","family":"Duffy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence","family":"Mwananyanda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roma","family":"Chilengi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leah","family":"Forman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Heeren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Gill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy","family":"Chavuma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Payne-Lohman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald M.","family":"Thea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,5,9]]},"reference":[{"key":"pone.0303253.ref001","unstructured":"Ministry of Health. Elimination of mother to child transmission of HIV and Syphilis. National operational plan 2019\u20132021. Lusaka: Ministry of Health; 2019.P.1-2."},{"issue":"2","key":"pone.0303253.ref002","volume":"9","author":"J Anna","year":"2022","journal-title":"Low Treatment Rates and Associated Factors Among Pregnant Women with Syphilis in Zambia, Open Forum Infectious Diseases"},{"key":"pone.0303253.ref003","unstructured":"WHO. Introduction. ln: WHO, editors. Guidelines on syphilis screening and treatment for pregnant women. Geneva: World health organization; 2017. P.10-12."},{"issue":"6","key":"pone.0303253.ref004","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1086\/655832","article-title":"Novel Treponema pallidum serologic tests: a paradigm shift in syphilis screening for the 21st century","volume":"51","author":"AC Se\u00f1a","year":"2010","journal-title":"Clin Infect Dis"},{"key":"pone.0303253.ref005","unstructured":"Centers for Disease Control and Prevention (CDC). Discordant results from reverse sequence syphilis screening\u2014five laboratories, United States, 2006\u20132010. MMWR Morb Mortal Wkly Rep. 2011 Feb 11;60(5):133\u20137. PMID: 21307823."},{"key":"pone.0303253.ref006","unstructured":"Ministry of Health. Maternal and newborn. Ln: Ministry of Health, editors. Annual health statistical report. Lusaka; Ministry of Health; 2017\u20132021. p. 28\u201336."},{"key":"pone.0303253.ref007","unstructured":"Ministry of Health. Syphilis. ln: Ministry of Health, editors. Zambia national sexually transmitted infections treatment guidelines. Lusaka: Ministry of Health;2023. p.32-34."},{"issue":"2","key":"pone.0303253.ref008","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1212\/01.CPJ.0000435752.17621.48","article-title":"Diagnostic tests for syphilis: New tests and new algorithms","volume":"4","author":"AF Henao-Mart\u00ednez","year":"2014","journal-title":"Neurol Clin Pract"},{"key":"pone.0303253.ref009","unstructured":"Ministry of Health. Diagnostic services. ln: Ministry of Health, editors. National Health strategic plan. 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Women accessing antenatal care (ANC) who were tested for syphilis (%) [internet]2021. Available from:https:\/\/www.who.int\/data\/gho\/data\/indicators\/indicator-details\/GHO\/women-accessing-antenatal-care-(anc)-services-who-were-tested-for-syphilis-(-)."},{"key":"pone.0303253.ref016","article-title":"Securing the supply of benzathine penicillin: a global perspective on risks and mitigation strategies to prevent future shortages","author":"S Frederic","year":"2023","journal-title":"International Health"},{"issue":"Suppl 1","key":"pone.0303253.ref017","first-page":"S73","article-title":"The cost-effectiveness of 10 antenatal syphilis screening and treatment approaches in Peru, Tanzania, and Zambia","volume":"1301","author":"F Terris-Prestholt","year":"2015","journal-title":"Int J Gynaecol Obstet"},{"issue":"5","key":"pone.0303253.ref018","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1097\/OLQ.0b013e3182036a0f","article-title":"The tale of two serologic tests to screen for syphilis\u2014treponemal and nontreponemal: does the order matter?","volume":"38","author":"K Jr Owusu-Edusei","year":"2011","journal-title":"Sex Transm Dis"},{"issue":"93","key":"pone.0303253.ref019","article-title":"Impact of intrapartum antimicrobial prophylaxis upon the intestinal microbiota and the prevalence of antibiotic resistance genes in vaginally delivered full term neonates","volume":"5","author":"A Nogacka","year":"2017","journal-title":"Microbiome"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0303253","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T17:55:04Z","timestamp":1715277304000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0303253"}},"subtitle":[],"editor":[{"given":"Antonella","family":"Marangoni","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,5,9]]},"references-count":19,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,5,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0303253","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,9]]}}}