反順序 （reverse algorithm）與傳統梅毒檢驗流程的異同及對臨床梅毒診斷可能帶來的影響

The Differences in Syphilis Diagnosis between Traditional and Reverse Testing Algorithm and Its Impact on Clinical Interpretation

梅毒是一個古老的疾病，雖然 penicillin 能有效的治療梅毒，但隨著性行為的開放，被通報的個案數並沒有減少。近年來隨著實驗室軌道系統的發展，以自動化的免疫分析來測試梅毒螺旋體抗體，來取代目前以 RPR/VDRL 來做為梅毒初步的篩檢方式被提出來，即所謂的反順序 （reverse algorithm） 的梅毒檢驗。雖然美國疾病管制局仍保留傳統的梅毒診斷流程，但也將反順序的梅毒檢驗列為替代方式。目前台灣有越來越多的實驗室已經導入自動化的軌道系統，在充分利用自動化軌道系統以減少檢驗人力的考量之下，可預期反順序的梅毒檢驗將會被更多的實驗室採用。而了解傳統和反順序梅毒診斷流程的異同，將是所有臨床醫護人員所不可或缺的知識。

Syphilis is a historic disease. Its prevalence rate remained high despite treatmentwith penicillin. With the advent of automatic systems used in clinical laboratories,the reverse algorithm has been suggested, which involves the replacement of thetraditional syphilis screening test (RPR/VDRL) with the immunoassay. To date, thereverse algorithm is approved by the Centers for Disease Control as an alternativemethod for syphilis diagnosis. As more automatic systems are available in theclinical laboratories in Taiwan, the reverse algorithm for syphilis diagnosis is mostlycommonly used. Understanding the differences between the traditional and reversealgorithms for syphilis diagnosis would be essential for all medical staffs.