Comparison of Syphilis Rapid Diagnostic Test to Rapid Plasma Reagin, Treponema pallidum Haemagglutination Assay and Fluorescent Treponemal Antibody-Absorption for Syphilis and Yaws Diagnostics

Astuti Giantini, Dewi Wulandari, Siskawati Suparmin


BACKGROUND: Syphilis and yaws are the treponemal infections which have become serious public health problems, and both are serologically indistinguishable. Developed serological tests for syphilis may also be used to diagnose yaws. In remote area, test modality with minimal requirements were needed. This study investigated the diagnostic value of syphilis rapid diagnostic test (RDT) in diagnosing syphilis and yaws.

METHODS: For syphilis diagnostic test, serum samples were obtained from patients of outpatient clinic in Dr. Cipto Mangunkusumo National Central General Hospital who were sent for rapid plasma reagin (RPR) and Treponema pallidum haemagglutination assay (TPHA) to clinical laboratory of the hospital. The serum samples were collected and stored at -80°C until the day of testing for syphilis RDT and fluorescent treponemal antibody-absorption (FTA-Abs). For yaws diagnostic test, serum samples were obtained as a part of surveillance study of yaws among children 1-15 years old in West Halmahera. Venous blood samples were used for syphilis RDT and the sera were separated and were sent to Dr. Cipto Mangunkusumo National Central General Hospital for RPR, TPHA, and FTA-Abs tests.

RESULTS: For syphilis diagnostic test, among 156 samples, 39 samples were positive with syphilis RDT. The sensitivity of syphilis RDT was similar to RPR and TPHA (100.0%), the specificity was same as TPHA (77.5%), but lower than RPR (84.8%) when compared to FTA-Abs IgM. The sensitivity of syphilis RDT was 62.5% and the specificity was 96.0% when compare to FTA-Abs IgG. For yaws diagnostic test, among 176 samples, 13 samples were positive with syphilis RDT. By using FTA-Abs IgM as gold standard for diagnosing yaws, the RDT have similar sensitivity (50.0%) with RPR and TPHA and syphilis RDT have similar specificity to TPHA (93.1%). If compared to FTA-Abs IgG, the sensitivity of syphilis RDT was 40.0% and the specificity was 98.0%.

CONCLUSION: Syphilis RDT gives similar results with TPHA in syphilis and yaws cases. It may be used as a first line screening test latent or untreated syphilis and yaws because of good sensitivity. For yaws diagnosis Syphilis RDT, RPR, and TPHA have low sensitivity, however all those tests have an excellent agreement.

KEYWORDS: FTA-Abs, rapid diagnostic test, syphilis, yaws


Full Text:



Daili SF, Indriatmi W, Wiweko SN, Dewi H, Tanudjaya F, Wignall S, et al. Pedoman Tata Laksana Sifilis Untuk Pengendalian Sifilis Di Layanan Kesehatan Dasar. Jakarta: Kementerian Kesehatan Republik Indonesia Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan; 2013.

World Health Organization. The Use of Rapid Syphilis Test. Switzerland: World Health Organization; 2006, article.

Ballard R, Hook III EW. Syphilis. In: Unemo M, Ballard R, Ison C, Lewis D, Ndowa F, Peeling R, editors. Laboratory diagnosis of sexually transmitted infections, including human immunodeficiency virus. Geneva: World Health Organization; 2013. p.107–30, article.

SD BIOSENSOR [Internet]. STANDARD Q Syphilis Ab [cited 2018 Mar 21]. Available from:

Marrouche N, Ghosn SH. Endemic (Nonvenereal) Treponematoses. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff C, editors. Fitzpatrick’s Dermatology in General Medicine. 8th ed. New York: McGraw-Hill; 2012. p.2493–500, NLMID.

Moeloek NF. Keputusan Menteri Kesehatan Republik Indonesia NOMOR HK.01.07/MENKES/496/2017 Tentang Daerah Endemis Frambusia. Jakarta: Kementrian Kesehatan RI; 2017.

Kementerian Kesehatan Republik Indonesia [Internet]. Kusta dan Frambusia Penyakit Terabaikan [updated 2010; cited 2018 Mar 21]. Available from: /.

World Health Organization [Internet]. Yaws [cited 2018 Mar 21]. Available from:

Kementerian Kesehatan RI. Peraturan Menteri Kesehatan Republik Indonesia Nomor 8 Tahun 2017 Tentang Eradikasi Frambusia. Jakarta: Kementrian Kesehatan RI; 2017.

Marks M, Goncalves A, Vahi V, Sokana O, Puiahi E, Zhang Z. Evaluation of a rapid diagnostic test for yaws infection in a community surveillance setting. PLoS Negl Trop Dis. 2014 Sep 11; 8: e3156, CrossRef.

Watson PF, Petrie A. Method agreement analysis: A review of correct methodology. Theriogenology. 2010; 73: 1167–79, CrossRef.

Sen˜a AC, White BL, Sparling PF. Novel Treponema pallidum serologic tests: a paradigm shift in syphilis screening for the 21st Century. Clin Infect Dis. 2010; 51: 700–8, CrossRef.

Braun-Falco O, Plewig G, Wolff H, Burgdoff W. Dermatology. 2nd ed. Verlag: Springer; 1965, NLMID.

Castro R, Lopes A, da Luz Martins Pereira F. Evaluation of an immunochromatographic point-of-care test for the simultaneous detection of nontreponemal and treponemal antibodies in patient with syphilis. Sex Transm Dis. 2014; 41: 467–9, CrossRef.

Morshed M, Singh AE. Recent trends in the serologic diagnosis of syphilis. Clin Vaccine Immunol. 2015; 22: 137–47, CrossRef.

Marks M, Lebari D, Solomon AW, Higgins SP. Yaws. Int J STD AIDS. 2014; 26: 696–703, CrossRef.

World Health Organization [Internet]. Yaws [cited 2018 Jul 13]. Available from:

Podgorski T, Bartkowiak U, Pawlak M. Comparison of hematological parameters of venous and capillary blood in athletes. Trends Sports Sci. 2014; 1: 39–45, article.

Hopkins D, Florez D. Comparison of RPR “teardrop” card test, VDRL, and FTA-Abs tst results on sera from persons with suspected yaws in Colombia. Br J Vener Dis. 1977; 53: 218–20, CrossRef.

Menke H, Veldkamp J, Brunings E, Niemel P, Notowicz A, Stolz E. Comparison of cardiolipin and treponemal tests in serodiagnosis of yaws. Br J Vener Dis. 1979; 55: 102–4, CrossRef.


Indexed by:






The Prodia Education and Research Institute