William J. Brown

EVALUATION OF RPR CARD TEST FOR SYPHILIS SCREENING IN FIELD INVESTIGATIONS.

T HE rapid plasma reagin (RPR) card test for syphilis was described by Portnoy and associates (1) as having the necessary components for an effective field test: (a) a rapid, simple method for obtaining plasma from finger-stick blood, requiring neither water bath nor centrifuge; (b) a stable antigen suspension; (c) rapid performance; and (d) adequate sensitivity and specificity. Preliminary evaluatiolns of the test were conducted at the venereal disease clinic of the Fulton County (Ga.) Health Department and the social hygiene clinic of the Houston (Tex.) City Health Department where the RPR card tests were performed by technologists from the Venereal Disease Research Laboratory. To evaluate the practicability of the RPR card test for use as a screening procedure in field investigations, 28 nontechnical venereal disease investigators from various sections of the country received a 2-day training course at the Venereal Disease Research Laboratory in the performance of the RPR card test. Each investigator was given an RPR card-testing kit with the following instructions: All named contacts to early infectious syphilis will be tested by both the RPR card test and by the VDRL quantitative slide test. In addition, all named contacts will have physical examinations in the clinic. For all others tested (suspects, associates, high-prevalence groups, and so on) the VDRL slide test is required only if the RPR card test is reactive. In this event, the venous specimen should be obtained at the time the reactive card test is noted and the patient brought to the clinic for examination.

Primary and secondary syphilis in the United States.

T IHE REPORTED incidence of primary and secondary syphilis in the United States continued to increase sharply and steadily during the 1959 and 1960 fiscal years following a slight increase in 1958. The increase continued in the first 9 months of fiscal year 1961; 14,019 cases of primary and secondary syphilis were reported during that period. Prior to 1958, a level trend appeared to be developing in the United States following the continuous decline from the postwar peak year of 1947 with the advent of mass penicillin chemotherapy. Figure 1 compares the trend of primary and secondary syphilis and gonorrhea case rates in the United States during fiscal years 1941 through 1960. The reported incidence rate of gonorrhea has only increased moderately during 1959 and 1960 in comparison with the increase in the reported incidence rate of primary and secondary syphilis. Venereal disease control personnel are confronted with the implications of the reported level of 12,000 cases in 1960 to a projected 19,000 cases in 1961 in the United States. What do the reported increases mean in terms of the present control program and what additional control measures are needed? Some statistical data on a na.tional scope related to this situation are presented in this report.