pertenue), bejel (or endemic syphilis) ( T. pallidum) and the so-called nonvenereal or endemic treponematoses (ETs) consisting of yaws ( T. These bacteria are the cause of both syphilis ( Treponema pallidum ssp. Treponematoses are infections caused by the spirochetal organisms of the Treponema species. We review the dilemmas in the diagnosis of endemic treponematoses, and advances in the discovery of new diagnostic tools. In the past ten years, there has been an increasing effort to apply polymerase chain reaction to treponematoses and whole genome fingerprinting techniques have identified genetic signatures that can differentiate the existing treponemal strains however, definitive diagnosis is also hampered by widespread unavailability of molecular diagnostics. Serological tests are still considered standard laboratory methods for the diagnosis of endemic treponematoses and new rapid point-of-care treponemal tests have become available which are extremely useful in low-resource settings. Traditionally, the human treponematoses have been differentiated based upon their clinical manifestations and epidemiologic characteristics because the etiologic agents are indistinguishable in the laboratory. doi: 10.1016/j.ijgo.2015.04.Improved understanding of the differential diagnosis of endemic treponematoses is needed to inform clinical practice and to ensure the best outcome for a new global initiative for the eradication of yaws, bejel, and pinta. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. The cost-effectiveness of 10 antenatal syphilis screening and treatment approaches in Peru, Tanzania, and Zambia. Terris-Prestholt F, Vickerman P, Torres-Rueda S, Santesso N, Sweeney S, Mallma P, et al. The effectiveness of antenatal syphilis screening and single-dose benzathine penicillin treatment for the prevention of adverse pregnancy outcomes. Watson-Jones D, Gumodoka B, Weiss H, Changalucha J, Todd J, Mugeye K, et al. Impact of maternal syphilis on outcome of pregnancy. Watson-Jones D, Changalucha J, Gumodoka B, Weiss H, Rusizoka M, Ndeki L, et al. Global Estimates of Syphilis in Pregnancy and Associated Adverse Outcomes: Analysis of Multinational Antenatal Surveillance Data. Newman L, Kamb M, Hawkes S, Gomez G, Say L, Seuc A, et al. Qualitative data is needed to help inform better training packages to support the implementation of POCT in low-resource settings. Although the test was considered to take a relatively long time to perform the benefits of improved access to testing were considered positive by most healthcare workers. Many healthcare workers related their experience with the POCT to their experience using similar tests for malaria. Alongside the implementation of the POCT we facilitated semi-structured interviews with both nurses and patients to explore individuals' experiences and beliefs in relation to use of the POCT.įour main themes emerged in the interviews: 1) training and ease of performing the test 2) time taken and ability to fit the test into a clinical workflow 3) perceived reliability and trustworthiness of the test and 4) level of the health care system the test was most usefully deployed. Treatment for those testing positive was provided, in line with Solomon Islands Ministry of Health and Medical Services' guidelines for syphilis and yaws respectively. Each site was provided with training and an SOP on the performance, interpretation and recording of results. The POCT was deployed in the outpatient and ante-natal departments of a district hospital and four rural health clinics served by the hospital. Prior to the study serology was only routinely available at the local district hospital. We conducted a qualitative study evaluating healthcare worker and patient perceptions of using a syphilis/yaws POCT in clinics in the East Malaita region of Malaita province in the Solomon Islands. Experience with malaria POCT roll-out in sub-Saharan Africa has demonstrated that both healthcare worker and patient beliefs may play a major role in shaping the real-world use of POCTs. Alongside the test's performance characteristics assessed through diagnostic evaluation, it is important to consider broader issues when rolling out a POCT. Point-of-care tests (POCTs) for syphilis and yaws allow testing without further development of infrastructure in populations where routine laboratory facilities are not available. Serological assays remain the most common diagnostic method for all treponemal infections. The human treponematoses comprise venereal syphilis and the three non-venereal or endemic treponematoses yaws, bejel, and pinta.
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