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The common syphilis screening test algorithm — a nontreponemal test, followed (if the results are positive) by a confirmatory treponemal test — has been reversed in some centers for economic reasons. To examine the ramifications of this reversal, the CDC reviewed the various testing algorithms used and the test interpretations provided by four high-volume New York City laboratories that routinely use automated treponemal tests for initial screening. They analyzed the results for 116,822 specimens tested at these laboratories between October 1, 2005, and December 1, 2006.
Treponemal tests were reactive for 6587 specimens (6%). Subsequent nontreponemal tests were nonreactive for 56% of these specimens (3% overall). Of 2512 discordant specimens…