{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:18:56Z","timestamp":1787840336985,"version":"build-2784847793"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Syphilis diagnosis can be confirmed by two testing algorithms. In the traditional algorithm, a nontreponemal test is used as a screening test to rule out syphilis which, if reactive, is confirmed by a treponemal test. In the reverse algorithm, a treponemal test is used as a screening test, which, if positive, is confirmed by a nontreponemal test. If the nontreponemal is negative, a second treponemal assay of a different principle is performed to resolve the discordant result. The aim of this study was to compare the traditional and reverse algorithms for the diagnosis of syphilis in a National Referral Apex Centre for Sexually Transmitted Infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>\n                      A retrospective study was done on samples received from male and female sexually transmitted infection clinics for syphilis testing. All samples were tested simultaneously using the Venereal Disease Research Laboratory (VDRL),\n                      <jats:italic toggle=\"yes\">Treponema pallidum<\/jats:italic>\n                      hemagglutination assay (TPHA), and fluorescent treponemal antibody absorption (FTA-Abs) test. The results of syphilis serological testing were interpreted using the traditional and reverse algorithms. The traditional algorithm used VDRL as the screening test and TPHA as the confirmatory test. In the reverse algorithm, TPHA was the screening test, and reactive results were confirmed with VDRL. Discordant samples were confirmed with the FTA-Abs test.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The reverse algorithm showed a significantly higher seroprevalence of syphilis than the traditional algorithm (62.4% vs. 40.8%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.0001). The traditional algorithm had a high missed serodiagnosis rate (34.6%) and showed a higher false-positive rate of the screening test (6.8%) as compared to the reverse algorithm (0.6%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This study supports the use of reverse algorithms for diagnosing syphilis in high-prevalence populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijstd.ijstd_132_24","type":"journal-article","created":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T06:00:17Z","timestamp":1749448817000},"page":"25-30","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Traditional versus reverse algorithm for diagnosis of syphilis \u2013 An Indian perspective from a national referral laboratory for sexually transmitted infections"],"prefix":"10.4103","volume":"46","author":[{"given":"Shiva","family":"Verma","sequence":"first","affiliation":[{"name":"Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India"},{"name":"Department of Microbiology, Era\u2019s Lucknow Medical College, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pragyan Swagatika","family":"Panda","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumathi","family":"Muralidhar","sequence":"additional","affiliation":[{"name":"Apex Regional STD Centre and SRL-HIV, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santhosh","family":"Rajan","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India"},{"name":"Department of Microbiology, ESI-PGIMSR, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niti","family":"Khunger","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Apex Regional STD Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,6,9]]},"reference":[{"key":"R1-20250617","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.1086\/429626","article-title":"History of syphilis","volume":"40","author":"Rothschild","year":"2005","journal-title":"Clin Infect Dis"},{"key":"R2-20250617","doi-asserted-by":"crossref","first-page":"S21","DOI":"10.1093\/cid\/ciaa306","article-title":"Syphilis laboratory guidelines:Performance characteristics of nontreponemal antibody tests","volume":"71","author":"Tuddenham","year":"2020","journal-title":"Clin Infect Dis"},{"key":"R3-20250617","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.plabm.2017.04.007","article-title":"Traditional versus reverse syphilis algorithms:A comparison at a large academic medical center","volume":"8","author":"Dunseth","year":"2017","journal-title":"Pract Lab Med"},{"key":"R4-20250617","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1128\/CVI.00681-14","article-title":"Recent trends in the serologic diagnosis of syphilis","volume":"22","author":"Morshed","year":"2015","journal-title":"Clin Vaccine Immunol"},{"key":"R5-20250617","first-page":"79","article-title":"Which algorithm should be used to screen for syphilis?Curr Opin Infect Dis","volume":"25","author":"Binnicker","year":"2012"},{"key":"R6-20250617","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5411\/wji.v6.i1.1","article-title":"Syphilis testing algorithms:A review","volume":"6","author":"Binder","year":"2016","journal-title":"World J Immunol"},{"key":"R7-20250617","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1093\/cid\/ciu087","article-title":"Analysis of 3 algorithms for syphilis serodiagnosis and implications for clinical management","volume":"58","author":"Tong","year":"2014","journal-title":"Clin Infect Dis"},{"key":"R8-20250617","first-page":"872","article-title":"Centers for Disease Control and Prevention (CDC). 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