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Author Notes:

E-mail Address: perezf@paho.org.

The authors gratefully acknowledge the participating laboratories for providing information through the survey and staff of the Ministries of Health of the region and Pan American Health Organization country offices for their support.



  • Science & Technology
  • Life Sciences & Biomedicine
  • Public, Environmental & Occupational Health
  • Tropical Medicine
  • syphilis testing
  • Pan American Health Organization
  • Americas
  • laboratory quality assurance
  • congenital Syphilis
  • elimination of mother-to-child transmission of syphilis and HIV

Syphilis testing practices in the Americas


Journal Title:

Tropical Medicine and International Health


Volume 22, Number 9


, Pages 1196-1203

Type of Work:

Article | Post-print: After Peer Review


Objective: To present the findings of the Pan American Health Organization's 2014 survey on syphilis testing policies and practices in the Americas. Methods: Representatives of national/regional reference and large, lower-level laboratories from 35 member states were invited to participate. A semi-structured, electronically administered questionnaire collected data on syphilis tests, algorithms, equipment/commodities, challenges faced and basic quality assurance (QA) strategies employed (i.e. daily controls, standard operating procedures, technician training, participating in external QA programmes, on-site evaluations). Results: The 69 participating laboratories from 30 (86%) member states included 41 (59%) national/regional reference and 28 (41%) lower-level laboratories. Common syphilis tests conducted were the rapid plasma reagin (RPR) (62% of surveyed laboratories), venereal disease research laboratory (VDRL) (54%), fluorescent treponemal antibody absorption (FTA-ABS) (41%) and Treponema pallidum haemagglutination assay (TPHA) (32%). Only three facilities reported using direct detection methods, and 28 (41% overall, 32% of lower-level facilities) used rapid tests. Most laboratories (62%) used only traditional testing algorithms (non-treponemal screening and treponemal confirmatory testing); however, 12% used only a reverse sequence algorithm (treponemal test first), and 14% employed both algorithms. Another nine (12%) laboratories conducted only one type of serologic test. Although most reference (97%) and lower-level (89%) laboratories used at least one QA strategy, only 16% reported using all five basic strategies. Commonly reported challenges were stock-outs of essential reagents or commodities (46%), limited staff training (73%) and insufficient equipment (39%). Conclusions: Many reference and clinical laboratories in the Americas face challenges in conducting appropriate syphilis testing and in ensuring quality of testing.

Copyright information:

© 2017 John Wiley & Sons Ltd.

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