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REVIEW

A review of recent advances in rapid point-of-care tests for syphilis

Claire C. Bristow A E , Elysia Larson B , Marjan Javanbakht A , Emily Huang C , Louise Causer D and Jeffrey D. Klausner A C
+ Author Affiliations
- Author Affiliations

A Fielding School of Public Health, University of California Los Angeles, 640 Charles E Young Drive South, Los Angeles, CA 90024, USA.

B Harvard School of Public Health, 677 Huntington Avenue, Cambridge, Boston, MA 02115, USA.

C David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.

D The Kirby Institute, Wallace Wurth Building, UNSW Australia, Sydney, NSW 2052, Australia.

E Corresponding author. Email: ccbristow@ucla.edu

Sexual Health 12(2) 119-125 https://doi.org/10.1071/SH14166
Submitted: 26 August 2014  Accepted: 20 November 2014   Published: 27 January 2015

Abstract

Syphilis is a curable disease, yet over 10 million people worldwide are infected with syphilis each year. Syphilis case finding and subsequent treatment are key steps in syphilis control and prevention efforts. The advent of rapid point-of-care tests – which require minimal equipment, are easy to perform and are relatively low cost – have the potential to improve syphilis control by allowing for more widespread testing in clinical and non-clinical settings. However, strategies to maximise the potential public health impact of those tests are needed, and those include regulatory oversight, effective supply-chain management and quality assurance systems.


References

[1]  World Health Organization (WHO). Global incidence and prevalence of selected curable sexually transmitted infections – 2008. Geneva: WHO; 2012.

[2]  World Health Organization (WHO). Prevention and treatment of HIV and other sexually transmitted infections among men who have sex with men and transgender people. Recommendations for a public health approach; 2011. Available online at: http://www.who.int/hiv/pub/guidelines/msm_guidelines2011/en/ [verified 15 December 2014].

[3]  World Health Organization (WHO). The global elimination of congenital syphilis: rationale and strategy for action; 2007. Available online at: http://www.who.int/reproductivehealth/publications/rtis/9789241595858/en/ [verified 15 December 2014].

[4]  World Health Organization (WHO). Elimination of mother-to-child transmission (EMTCT) of HIV and syphilis: global guidance on criteria and processes for validation; 2014. Available online at: http://wwwwhoint/reproductivehealth/publications/rtis/9789241505888/en/ [verified 15 December 2014].

[5]  Hossain M, Broutet N, Hawkes S. The elimination of congenital syphilis: a comparison of the proposed World Health Organization action plan for the elimination of congenital syphilis with existing national maternal and congenital syphilis policies. Sex Transm Dis 2007; 34 S22–30.
The elimination of congenital syphilis: a comparison of the proposed World Health Organization action plan for the elimination of congenital syphilis with existing national maternal and congenital syphilis policies.Crossref | GoogleScholarGoogle Scholar | 17592387PubMed |

[6]  Kamb ML. Congenital syphilis: not gone and all too forgotten. World J Ped 2010; 6 101–2.
Congenital syphilis: not gone and all too forgotten.Crossref | GoogleScholarGoogle Scholar |

[7]  Kamb ML, Newman LM, Riley PL, Mark J, Hawkes SJ, Malik T, Broutet N. A road map for the global elimination of congenital syphilis. Obstet Gynecol Int 2010; 2010 312 798
A road map for the global elimination of congenital syphilis.Crossref | GoogleScholarGoogle Scholar |

[8]  Peeling RW, Holmes KK, Mabey D, Ronald A. Rapid tests for sexually transmitted infections (STIs): the way forward. Sex Transm Infect 2006; 82 v1–6.
Rapid tests for sexually transmitted infections (STIs): the way forward.Crossref | GoogleScholarGoogle Scholar | 17151023PubMed |

[9]  Tucker JD, Bien CH, Peeling RW. Point-of-care testing for sexually transmitted infections: recent advances and implications for disease control. Curr Opin Infect Dis 2013; 26 73–9.
Point-of-care testing for sexually transmitted infections: recent advances and implications for disease control.Crossref | GoogleScholarGoogle Scholar | 23242343PubMed |

[10]  Tucker JD, Bu J, Brown LB, Yin YP, Chen XS, Cohen MS. Accelerating worldwide syphilis screening through rapid testing: a systematic review. Lancet Infect Dis 2010; 10 381–6.
Accelerating worldwide syphilis screening through rapid testing: a systematic review.Crossref | GoogleScholarGoogle Scholar | 20510278PubMed |

[11]  Tucker JD, Hawkes SJ, Yin YP, Peeling RW, Cohen MS, Chen XS. Scaling up syphilis testing in China: implementation beyond the clinic. Bull World Health Organ 2010; 88 452–7.
Scaling up syphilis testing in China: implementation beyond the clinic.Crossref | GoogleScholarGoogle Scholar | 20539859PubMed |

[12]  Yang LG, Tucker JD, Liu FY, Ren X-Q, Hong X, Wang C, McLaughlin MM, Bien CH, Chen X-S, Yang B. Syphilis screening among 27,150 pregnant women in South Chinese rural areas using point-of-care tests. PLoS ONE 2013; 8 e72149
Syphilis screening among 27,150 pregnant women in South Chinese rural areas using point-of-care tests.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXhsVagtb7F&md5=25197dbe8b59c7589944464f7b72c44fCAS | 24009673PubMed |

[13]  Fitzgerald DW, Behets FM, Lucet C, Roberfroid D. Prevalence, burden, and control of syphilis in Haiti’s rural Artibonite region. Int J Infect Dis 1998; 2 127–31.
Prevalence, burden, and control of syphilis in Haiti’s rural Artibonite region.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c3ks1Gruw%3D%3D&md5=18a5965c8d45fc0a21c4a387402088e7CAS | 9531657PubMed |

[14]  Fonn S. A blood-result turn-around time survey to improve congenital syphilis prevention in a rural area. South African Med J 1996; 86 67–71.
| 1:STN:280:DyaK283kvFWktQ%3D%3D&md5=3c1e9d5172129570a421cb8724fb6712CAS |

[15]  Holmes KK. Sexually transmitted diseases, 4th edn. New York: McGraw-Hill Medical; 2008.

[16]  Klausner JD, Hook E.W. Current diagnosis & treatment of sexually transmitted diseases. Columbus: The McGraw-Hill Companies, Inc.; 2007.

[17]  Centers for Disease Control and Prevention (CDC) Discordant results from reverse sequence syphilis screening–five laboratories, United States, 2006–2010. MMWR Morb Mortal Wkly Rep 2011; 60 133–7.
| 21307823PubMed |

[18]  Garcia PJ, Carcamo CP, Chiappe M, Valderrama M, La Rosa S, Holmes KK, Mabey DCW, Peeling RW. Rapid syphilis tests as catalysts for health systems strengthening: a case study from Peru. PLoS ONE 2013; 8 e66905
Rapid syphilis tests as catalysts for health systems strengthening: a case study from Peru.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXhtFSjsrnK&md5=89d548f70b94cd46bc819ea124ba404eCAS | 23840552PubMed |

[19]  Kuznik A, Lamorde M, Nyabigambo A, Manabe YC. Antenatal syphilis screening using point-of-care testing in Sub-Saharan African countries: a cost-effectiveness analysis. PLoS Med 2013; 10 e1001545
Antenatal syphilis screening using point-of-care testing in Sub-Saharan African countries: a cost-effectiveness analysis.Crossref | GoogleScholarGoogle Scholar | 24223524PubMed |

[20]  Mabey D, Peeling RW, Ustianowski A, Perkins MD. Diagnostics for the developing world. Nat Rev Microbiol 2004; 2 231–40.
Diagnostics for the developing world.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2cXhsVWgur0%3D&md5=014e29384221363a910134c19d816eefCAS | 15083158PubMed |

[21]  Herring AJ, Ballard RC, Pope V, Adegbola RA, Changalucha J, Fitzgerald DW, Hook EW. Herring AJ, Ballard RC, Pope V, Adegbola RA, Changalucha J, Fitzgerald DW, Hook EW. A multi-centre evaluation of nine rapid, point-of-care syphilis tests using archived sera. Sex Transm Infect 2006; 82 v7–12.
A multi-centre evaluation of nine rapid, point-of-care syphilis tests using archived sera.Crossref | GoogleScholarGoogle Scholar | 17118953PubMed |

[22]  Gaydos C, Hardick J. Point of care diagnostics for sexually transmitted infections: perspectives and advances. Expert Rev Anti Infect Ther 2014; 12 657–72.
Point of care diagnostics for sexually transmitted infections: perspectives and advances.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC2cXotVelur0%3D&md5=d1627ef4ca0801b6b22b9d4524a969b6CAS | 24484215PubMed |

[23]  Guinard J, Prazuck T, Pere H, et al Usefulness in clinical practice of a point-of-care rapid test for simultaneous detection of nontreponemal and Treponema pallidum-specific antibodies in patients suffering from documented syphilis. Int J STD AIDS 2013; 24 944–50.
Usefulness in clinical practice of a point-of-care rapid test for simultaneous detection of nontreponemal and Treponema pallidum-specific antibodies in patients suffering from documented syphilis.Crossref | GoogleScholarGoogle Scholar | 23999937PubMed |

[24]  Jafari Y, Peeling RW, Shivkumar S, Claessens C, Joseph L, Pai NP. Are Treponema pallidum specific rapid and point-of-care tests for syphilis accurate enough for screening in resource limited settings? Evidence from a meta-analysis. PLoS ONE 2013; 8 e54695
Are Treponema pallidum specific rapid and point-of-care tests for syphilis accurate enough for screening in resource limited settings? Evidence from a meta-analysis.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXjsl2jsbc%3D&md5=dfdbcc4591f724099851e11bd5b8bad7CAS | 23468842PubMed |

[25]  Kay NS, Peeling RW, Mabey DC. State of the art syphilis diagnostics: rapid point-of-care tests. Expert Rev Anti Infect Ther 2014; 12 63–73.
State of the art syphilis diagnostics: rapid point-of-care tests.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC2cXht1Ortr4%3D&md5=b7fd7667c59348834cb3110e5fa76ae2CAS | 24308715PubMed |

[26]  World Health Organization (WHO). WHO bulk procurement; 2012.

[27]  Owusu-Edusei K, Gift TL, Ballard RC. Cost-effectiveness of a dual non-treponemal/treponemal syphilis point-of-care test to prevent adverse pregnancy outcomes in sub-Saharan Africa. Sex Transm Dis 2011; 38 997–1003.
Cost-effectiveness of a dual non-treponemal/treponemal syphilis point-of-care test to prevent adverse pregnancy outcomes in sub-Saharan Africa.Crossref | GoogleScholarGoogle Scholar | 21992974PubMed |

[28]  Kahn JG, Jiwani A, Gomez GB, et al The cost and cost-effectiveness of scaling up screening and treatment of syphilis in pregnancy: a model. PLoS ONE 2014; 9 e87510
The cost and cost-effectiveness of scaling up screening and treatment of syphilis in pregnancy: a model.Crossref | GoogleScholarGoogle Scholar | 24489931PubMed |

[29]  Tuite AR, Burchell AN, Fisman DN. Cost-effectiveness of enhanced syphilis screening among HIV-positive men who have sex with men: a microsimulation model. PLoS ONE 2014; 9 e101240
Cost-effectiveness of enhanced syphilis screening among HIV-positive men who have sex with men: a microsimulation model.Crossref | GoogleScholarGoogle Scholar | 24983455PubMed |

[30]  Sweeney S, Mosha JF, Terris-Prestholt F, et al The costs of accessible quality assured syphilis diagnostics: informing quality systems for rapid syphilis tests in a Tanzanian setting. Health Policy Plan 2013; 29 633–41.
| 23894075PubMed |

[31]  Lewandrowski K, Gregory K, Macmillan D. Assuring quality in point-of-care testing: evolution of technologies, informatics, and program management. Arch Pathol Lab Med 2011; 135 1405–14.
Assuring quality in point-of-care testing: evolution of technologies, informatics, and program management.Crossref | GoogleScholarGoogle Scholar | 22032566PubMed |

[32]  Mabey DC, Sollis KA, Kelly HA, et al Point-of-care tests to strengthen health systems and save newborn lives: the case of syphilis. PLoS Med 2012; 9 e1001233
Point-of-care tests to strengthen health systems and save newborn lives: the case of syphilis.Crossref | GoogleScholarGoogle Scholar | 22719229PubMed |

[33]  Castro AR, Mody HC, Parab SY, et al An immunofiltration device for the simultaneous detection of non-treponemal and treponemal antibodies in patients with syphilis. Sex Transm Infect 2010; 86 532–6.
An immunofiltration device for the simultaneous detection of non-treponemal and treponemal antibodies in patients with syphilis.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3cbpslOntQ%3D%3D&md5=b1169c007a1ee0fee8c7be3c5be67b84CAS | 20656720PubMed |

[34]  Causer LM, Kaldor JM, Fairley CK, et al A laboratory-based evaluation of four rapid point-of-care tests for syphilis. PLoS ONE 2014; 9 e91504
A laboratory-based evaluation of four rapid point-of-care tests for syphilis.Crossref | GoogleScholarGoogle Scholar | 24618681PubMed |

[35]  Yin YP, Chen XS, Wei WH, et al A dual point-of-care test shows good performance in simultaneously detecting nontreponemal and treponemal antibodies in patients with syphilis: a multisite evaluation study in China. Clin Infect Dis 2013; 56 659–65.
A dual point-of-care test shows good performance in simultaneously detecting nontreponemal and treponemal antibodies in patients with syphilis: a multisite evaluation study in China.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXit1Wmt7g%3D&md5=01ede5f3b95f7dd941ebdf968d4b6250CAS | 23132172PubMed |

[36]  Castro AR, Esfandiari J, Kumar S, et al Novel point-of-care test for simultaneous detection of nontreponemal and treponemal antibodies in patients with syphilis. J Clin Microbiol 2010; 48 4615–9.
Novel point-of-care test for simultaneous detection of nontreponemal and treponemal antibodies in patients with syphilis.Crossref | GoogleScholarGoogle Scholar | 20881177PubMed |

[37]  Bristow CC, Adu-Sarkodie Y, Ondondo RO, et al Multi-site laboratory evaluation of a dual HIV/syphilis point-of-care rapid test for simultaneous detection of HIV and syphilis Open Forum Infect Dis 2014; 1
Multi-site laboratory evaluation of a dual HIV/syphilis point-of-care rapid test for simultaneous detection of HIV and syphilisCrossref | GoogleScholarGoogle Scholar |

[38]  MedMira multiplo rapid syphilis/HIV antibody test. 2013. Available online at: http://wwwmedmiracom/images/uploads/MPSIABPM0001EN_Rev_1_1pdf [verified 15 December 2014].

[39]  BIOLINE HIV/Syphilis Duo. 2013. Available online at: http://www.standardia.com/en/home/product/rapid/infectious-disease/HIVSyphilisDuo.html [verified 15 December 2014].

[40]  Chembio Inc. Chembio DPP® HIV-Syphilis assay. 2013. Available online at: http://chembiocom/wp-content/uploads/2013/10/MS-12-021-HIV-Syphilis-Sell-Sheet-Rev-3pdf [verified15 December 2014].

[41]  Dlamini NR, Phili R, Connolly C. Evaluation of rapid syphilis tests in KwaZulu-Natal. J Clin Lab Anal 2014; 28 77–81.
Evaluation of rapid syphilis tests in KwaZulu-Natal.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC2cXpsF2ksw%3D%3D&md5=0827e67aee24a814b56130b2135e2335CAS | 24395488PubMed |

[42]  Mamoojee Y, Tan G, Gittins S, et al Diagnosis of treponemal co-infection in HIV-infected West Africans. Tropical Med Int Health 2012; 17 1521–6.
Diagnosis of treponemal co-infection in HIV-infected West Africans.Crossref | GoogleScholarGoogle Scholar |

[43]  Zhuang YH, Tian Y, Chen Y, et al Evaluation of the Determine Syphilis TP assay for the detection of antibodies against Treponema pallidum for the serodiagnosis of syphilis Euro J Clin Microbiol Infect Dis 2012; 31 929–35.
Evaluation of the Determine Syphilis TP assay for the detection of antibodies against Treponema pallidum for the serodiagnosis of syphilisCrossref | GoogleScholarGoogle Scholar |

[44]  Jost H, Castro A, Cox D, et al A comparison of the analytical level of agreement of nine treponemal assays for syphilis and possible implications for screening algorithms BMJ Open 2013; 3 e003347
| 24056483PubMed |

[45]  Benzaken AS, Sabido M, Galban E, et al Field performance of a rapid point-of-care diagnostic test for antenatal syphilis screening in the Amazon region, Brazil. Int J STD AIDS 2011; 22 15–8.
Field performance of a rapid point-of-care diagnostic test for antenatal syphilis screening in the Amazon region, Brazil.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3M3jtVemsQ%3D%3D&md5=7d430a63f1ad3ac6cb73d916a7b20429CAS | 21364061PubMed |

[46]  Bergman J, Gratrix J, Plitt S, Fenton J, Archibald C, Wong T, Singh AE. Feasibility and field performance of a simultaneous syphilis and HIV point-of-care test based screening strategy in at risk populations in Edmonton, Canada. Aids Res Treat 2013; 2013 819593
Feasibility and field performance of a simultaneous syphilis and HIV point-of-care test based screening strategy in at risk populations in Edmonton, Canada.Crossref | GoogleScholarGoogle Scholar | 24527210PubMed |

[47]  Mishra S, Naik B, Venugopal B, et al Syphilis screening among female sex workers in Bangalore, India: comparison of point-of-care testing and traditional serological approaches. Sex Transm Infect 2010; 86 193–8.
Syphilis screening among female sex workers in Bangalore, India: comparison of point-of-care testing and traditional serological approaches.Crossref | GoogleScholarGoogle Scholar | 19965800PubMed |

[48]  Smit PW, Mabey D, van der Vlis T, Korporaal H, Mingara J, Changalucha J, Todd J, Peeling RW. The implementation of an external quality assurance method for point-of-care tests for HIV and syphilis in Tanzania. BMC Infect Dis 2013; 13 530
The implementation of an external quality assurance method for point-of-care tests for HIV and syphilis in Tanzania.Crossref | GoogleScholarGoogle Scholar | 24206624PubMed |

[49]  Diaz T, Almeida MG, Georg I, Maia SC, De Souza RV, Markowitz LE. Evaluation of the Determine Rapid Syphilis TP assay using sera. Clin Diagn Lab Immunol 2004; 11 98–101.
| 14715552PubMed |

[50]  World Health Organization (WHO). The use of rapid syphilis tests. 2006. Available online at: http://whqlibdoc.who.int/hq/2006/TDR_SDI_06.1_eng.pdf [verified 15 December 2014].

[51]  Vickerman P, Peeling RW, Terris-Prestholt F, et al Modelling the cost-effectiveness of introducing rapid syphilis tests into an antenatal syphilis screening programme in Mwanza, Tanzania. Sex Transm Infect 2006; 82 v38–43.
Modelling the cost-effectiveness of introducing rapid syphilis tests into an antenatal syphilis screening programme in Mwanza, Tanzania.Crossref | GoogleScholarGoogle Scholar | 17215276PubMed |

[52]  World Health Organization (WHO). Prequalification of in vitro diagnostics. 2014. Available online at: http://www.who.int/diagnostics_laboratory/evaluations/en/ [verified15 December 2014].

[53]  World Health Organization (WHO). Procurement of in vitro diagnostics. 2014. Available online at: http://www.who.int/diagnostics_laboratory/procurement/en/ [verified 15 December 2014].

[54]  El-Sadr WM, Philip NM, Justman J. Letting HIV transform academia–embracing implementation science. N Engl J Med 2014; 370 1679–81.
Letting HIV transform academia–embracing implementation science.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC2cXotVemsb8%3D&md5=f8ff8c74c4011fab796c652cece71c36CAS | 24785205PubMed |

[55]  Peeling RW, Ronald A. Diagnostic challenges of sexually transmitted infections in resource-limited settings. Future Microbiol 2009; 4 1271–82.
Diagnostic challenges of sexually transmitted infections in resource-limited settings.Crossref | GoogleScholarGoogle Scholar | 19995188PubMed |

[56]  Dinh TH, Kamb ML, Msimang V, et al Integration of preventing mother-to-child transmission of HIV and syphilis testing and treatment in antenatal care services in the Northern Cape and Gauteng provinces, South Africa. Sex Transm Dis 2013; 40 846–51.
Integration of preventing mother-to-child transmission of HIV and syphilis testing and treatment in antenatal care services in the Northern Cape and Gauteng provinces, South Africa.Crossref | GoogleScholarGoogle Scholar | 24113405PubMed |

[57]  Klausner JD. The sound of silence: missing the opportunity to save lives at birth. Bull World Health Org 2013; 91 158–158A.
The sound of silence: missing the opportunity to save lives at birth.Crossref | GoogleScholarGoogle Scholar | 23476083PubMed |

[58]  Lochhead MJ, Todorof K, Delaney M, et al Rapid multiplexed immunoassay for simultaneous serodiagnosis of HIV-1 and coinfections. J Clin Microbiol 2011; 49 3584–90.
Rapid multiplexed immunoassay for simultaneous serodiagnosis of HIV-1 and coinfections.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXhsVOrsbzJ&md5=6485d2b0bbb286dd3edddb1abbeda587CAS | 21865431PubMed |

[59]  Narula T, Kamboj S, Martinez J, Engel LS. Co-infection: HIV and the great mimic syphilis. HIV Clin 2010; 22 7–10.
| 20806799PubMed |

[60]  Pai NP, Kurji J, Singam A, et al Simultaneous triple point-of-care testing for HIV, syphilis and hepatitis B virus to prevent mother-to-child transmission in India. Int J STD AIDS 2012; 23 319–24.
Simultaneous triple point-of-care testing for HIV, syphilis and hepatitis B virus to prevent mother-to-child transmission in India.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC38nns1WgtA%3D%3D&md5=bc48debaec1b69e360796a0ef98036acCAS | 22648884PubMed |

[61]  Strasser S, Bitarakwate E, Gill M, et al Introduction of rapid syphilis testing within prevention of mother-to-child transmission of HIV programs in Uganda and Zambia: a field acceptability and feasibility study. J Acquir Immune Defic Syndr 2012; 61 e40–6.
Introduction of rapid syphilis testing within prevention of mother-to-child transmission of HIV programs in Uganda and Zambia: a field acceptability and feasibility study.Crossref | GoogleScholarGoogle Scholar | 22820810PubMed |

[62]  Esfandiari J, Gunasekera D, Sayegh F, et al. Performance evaluation of the Chembio DPP® HIV-Syphilis assay: a novel, point-of-care rapid HIV 1/2 and syphilis. Abstract presented at: 2012 HIV Diagnostics Conference 2012; 12 December 2012; Atlanta, GA. Available online at: https://custom.cvent.com/ADE0EB81B3184D618E2FB8340F1EC28E/files/29f3717707a44f91859f65feb4cefec6.pdf

[63]  Baguley SD, Horner PJ, Maple PA, Stephenson L. An oral fluid test for syphilis. Int J STD AIDS 2005; 16 299–301.
An oral fluid test for syphilis.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2M3lvV2ksw%3D%3D&md5=b6e2006acc4d043454d0b2a0dd320ab7CAS | 15899083PubMed |

[64]  Castro L, Leon S, Hasebe H, et al. Evaluation of oral fluid specimens for syphilis testing. 2006 National STD Prevention Conference Jacksonville, Florida; 2006. Available online at: https://cdc.confex.com/cdc/std2006/techprogram/P12106.HTM [verified 15 December 2014].

[65]  Maple PA, Simms I, Kafatos G, Solomou M, Fenton K. Application of a noninvasive oral fluid test for detection of treponemal IgG in a predominantly HIV-infected population Eur J Clin Microbiol Infect Dis 2006; 25 743–9.
Application of a noninvasive oral fluid test for detection of treponemal IgG in a predominantly HIV-infected populationCrossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD28Xht1WrtL7K&md5=5c1375144ca1e67bd24e95d2aec39341CAS | 17061098PubMed |