8% had a sero-positive TPHA result (original figure, prior to estimation using weighted proportions).
Notwithstanding the substantial number of patients who reported high-risk sexual behaviour, no statistically significant association was found between such behaviour and sero-positive TPHA results, in contrast to previous research.
The RPR test had an unacceptably low sensitivity as a syphilis screening procedure, indicating a low syphilis prevalence of only 1% (the TPHA test indicated a prevalence of 11.
This should include a combination of molecular analysis, fluorescent treponemal antibody absorption (FTA-abs), TPHA measurement at a higher dilution (to counter the effect of possible hypergammaglobulinaemia), total IgG, and screening for autoimmune diseases with anti-nuclear factor measurement.
Both the RPR and TPHA tests should be performed in parallel, which increases the sensitivity dramatically.
CONCLUSIONS: The overall prevalence of syphilis in psychiatric inpatients at Weskoppies Hospital as determined by
TPHA testing was higher than anticipated.
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