Análise da concordância de um teste rápido treponêmico com um teste VDRL com vistas ao seu emprego na triagem reversa da sífilis em gestantes durante o pré-natal no Brasil
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Data
2013-09-13
Autores
Degaut, Andressa Bolzan
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Universidade Federal do Espírito Santo
Resumo
Introduction: The present study used information from the Sentinel Childbirth Study for 2010/2011 (Estudo Sentinela Parturientes) under the Ministry of Health as source of data. Objectives: To analyze the concordance of a rapid treponemal test with a VDRL test and with laboratory routine flow sheet testing used for syphilis diagnosis in Brazil. To assess how often the ministerial protocol recommendations for syphilis diagnosis during the mother’s prenatal and delivery periods have been complied. Methods: serum samples from 2.426 women ready to give birth were selected out of a total of 38.393, who met the criteria for blood sampling: positive results for syphilis diagnosed by means of rapid test at the time of admission in a hospital or the absence of a syphilis screening during prenatal period. These samples were sent to the study reference laboratory where the VRDL test would be carried out. In case of a positive finding, the test TPHA – study flow chart, would be carried out. The Kappa test was used to analyze the concordance between rapid and VDRL tests. The frequency of agreement between the final results of the flow chart and the rapid test performed at the maternity hospital was also calculated. The descriptive analysis of the study results also includes socio-demographic data from the women ready to give birth and information on prenatal medical consultations. Results: The rapid treponemal test presented a concordance of 83.4% (Kappa) when compared to the non-treponemal VDRL test. The rapid test was positive to 95.6% of the 298 expectant mothers who had a syphilis positive laboratory result according to the procedures used (VDRL and reagent TPHA). Of the 303 expectant mothers with a positive result for syphilis, 23.3% were between 30-39 years old; 38% were between the 5th and the 8th grade (incomplete) of middle school or its equivalent; and 51.7% were brown-skinned individuals. Most of the expectant mothers (91.7%) had prenatal tests performed; 74.3% (225) had the test 1 for VDRL, of which 41.3 had a non-reactive result. Of the 38.3% (116) expectant mothers who got the test 2 for VDRL, 36.2% had a non-reactive result. Conclusion: The rapid treponemal test presented an outstanding concordance with the VDRL test, and considering the growth in its use during the prenatal period, it can be considered as a parameter to indicate the immediate beginning of treatment for syphilis in expectant mothers. Due to the high frequency of agreement (95.6%) with laboratory results (VDRL e positive TPHA), the rapid test can improve diagnosis and treatment to expectant mothers during prenatal medical consultations, with no need to wait for the laboratory result. Considering women with a positive result at the delivery moment, we can conclude that expectant mothers are still acquiring syphilis during pregnancy. We can also conclude that the compliance of the ministerial protocols for both tests during prenatal period and at the delivery moment should be broadened. In this context, the rapid test can perform a crucial role in promoting early diagnosis for expectant mothers and provide the due treatment, aiming to reduce congenital syphilis and to break the syphilis transmission chain.
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Sífilis , Cuidado pré-natal , Gestantes