Receipt of antimicrobial therapy by those ill enough to require transfusion support may also be important in preventing either infection or the recognition of transfusion syphilis. From a biological standpoint, it must be emphasized that the spirochetemia associated with transfusion transmissibility of T. pallidum generally occurs before the STS is reactive and spirochetemic donations are being transfused as we speak. Further information concerning T. pallidum survival under blood and platelet storage conditions, and the application of molecular techniques to assess the presence of T. pallidum DNA in serologically positive units, would allow better assessment of this question. Data presented at the AABB Annual Meeting in 1999 address this recommendation. On the other hand, the CDC data demonstrate spirochetemia by sensitive DNA tests.
Syphilis testing is likely to identify less than one such donor annually within the United States.
This low efficacy of syphilis testing as a surrogate marker of HIV is not sufficient by itself to warrant its application to all blood donors. We are aware of CDC data suggesting there are early syphilis cases being reported among blood and plasma donors. Unfortunately, as the CDC investigators admit, they are unable to segregate paid plasma donors from volunteer whole blood donors in their data, which we view as a serious flaw. Taken against the background of historically low infectious syphilis rates in this country and the failure of clinicians to recognize even isolated cases of transfusion associated syphilis, we question the applicability of the CDC data to the volunteer whole blood donor sector. Ramsey and Sherman reviewed FDA reported blood component recalls in the US from 1990 through 1997.