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Papp JR, Park IU, Fakile Y, Pereira L, Pillay A, Bolan GA. CDC Laboratory Recommendations for Syphilis Testing, United States, 2024. MMWR Recomm Rep 2024; 73:1-32. [PMID: 38319847 PMCID: PMC10849099 DOI: 10.15585/mmwr.rr7301a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
This report provides new CDC recommendations for tests that can support a diagnosis of syphilis, including serologic testing and methods for the identification of the causative agent Treponema pallidum. These comprehensive recommendations are the first published by CDC on laboratory testing for syphilis, which has traditionally been based on serologic algorithms to detect a humoral immune response to T. pallidum. These tests can be divided into nontreponemal and treponemal tests depending on whether they detect antibodies that are broadly reactive to lipoidal antigens shared by both host and T. pallidum or antibodies specific to T. pallidum, respectively. Both types of tests must be used in conjunction to help distinguish between an untreated infection or a past infection that has been successfully treated. Newer serologic tests allow for laboratory automation but must be used in an algorithm, which also can involve older manual serologic tests. Direct detection of T. pallidum continues to evolve from microscopic examination of material from lesions for visualization of T. pallidum to molecular detection of the organism. Limited point-of-care tests for syphilis are available in the United States; increased availability of point-of-care tests that are sensitive and specific could facilitate expansion of screening programs and reduce the time from test result to treatment. These recommendations are intended for use by clinical laboratory directors, laboratory staff, clinicians, and disease control personnel who must choose among the multiple available testing methods, establish standard operating procedures for collecting and processing specimens, interpret test results for laboratory reporting, and counsel and treat patients. Future revisions to these recommendations will be based on new research or technologic advancements for syphilis clinical laboratory science.
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Rodríguez I, Noda AA, Bosshard PP, Lienhard R. Anti-Treponema pallidum IgA response as a potential diagnostic marker of syphilis. Clin Microbiol Infect 2023; 29:1603.e1-1603.e4. [PMID: 37611864 DOI: 10.1016/j.cmi.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES Serological tests for syphilis detect mainly total Ig, IgM or IgG antibodies. We aimed to evaluate the specific IgA response in syphilis patients according to disease stage. METHODS A serum IgA-enzyme immunoassay was developed using commercially available microplates coated with recombinant treponemal antigens and an anti-IgA-conjugate. To define a cut-off, we used 91 syphilis positive and 136 negative sera previously defined by the rapid plasma reagin and the Treponema pallidum particle agglutination results. Then we determined the intra- and inter-assay precisions, diagnostic sensitivity according to the clinical stage (in 66, 55 and 42 sera from primary, secondary and latent syphilis patients, respectively) and specificity (in 211 sera from people with conditions different to syphilis). IgA values were further measured in 71 sera from patients with previously treated syphilis. RESULTS The newly developed IgA-enzyme immunoassay showed a good discrimination between negative and positive samples with intra- and inter-assay variation coefficients <20%. The sensitivity was 80.3% (95% CI, 70.0-90.6), 100.0% (95% CI, 99.1-100.0) and 95.2% (95% CI, 87.6-100.0) in primary, secondary and latent syphilis, respectively, and the specificity was 98.1% (95% CI, 96.0-100.0). Further, IgA values were negative in 61.3% (38/62) of patients with previously treated syphilis. DISCUSSION Our findings suggest serum IgA as a sensitive and specific marker of syphilis and its detection could be used as a screening assay for active infection. Further evaluation is needed in prospective longitudinal field studies.
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Affiliation(s)
- Islay Rodríguez
- National Reference Laboratory of Treponemes and Special Pathogens, Tropical Medicine Institute "Pedro Kourí", Havana, Cuba.
| | - Angel A Noda
- National Reference Laboratory of Treponemes and Special Pathogens, Tropical Medicine Institute "Pedro Kourí", Havana, Cuba
| | - Philipp P Bosshard
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Scherler G, Tomaske M, Cannizzaro V, Steppacher A, Zucol F, Theiler M, Toutous Trellu L, Labutin A, Bosshard PP, Berger C, Meyer Sauteur PM. Congenital syphilis in Switzerland: a retrospective cohort study, 2010 to 2019. Swiss Med Wkly 2023; 153:40121. [PMID: 37988348 DOI: 10.57187/smw.2023.40121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
AIMS OF THE STUDY We previously reported a re-emergence of syphilis from 2006 to 2009 with detection of congenital syphilis in Switzerland. This study aimed to reassess the incidence of children exposed to maternal syphilis during pregnancy and congenital syphilis in a following 10-year period in the canton of Zurich, the most populous canton in Switzerland with the highest incidences of syphilis. METHODS Children were identified both by reviewing medical records at the four major neonatal and paediatric hospitals providing acute care in the canton of Zurich and by the serological database of the syphilis reference laboratory. Inclusion criteria for children were (a) date of birth in the period 2010-2019, (b) place of birth in the canton of Zurich, (c) evaluation for syphilis due to positive syphilis pregnancy screening and (d) age <1 year at diagnosis. Results were compared with epidemiological data provided by the Federal Office of Public Health (FOPH). RESULTS We identified and evaluated 17 children after potential exposure to maternal syphilis. Residual antibodies of a past infection were found in 11 mothers. Six children were identified as having had real exposure to asymptomatic maternal syphilis. From an epidemiological perspective, the distribution of the cases followed a similar pattern as confirmed syphilis cases in women of childbearing age reported to the FOPH. No cases of congenital syphilis were observed. CONCLUSIONS In contrast to the rise in syphilis infections, this study identified no cases of congenital syphilis in the canton of Zurich, Switzerland, in the period 2010-2019. Syphilis pregnancy screening may have prevented congenital syphilis by diagnosing and allowing adequate treatment of asymptomatic maternal syphilis.
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Affiliation(s)
- Gioia Scherler
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Maren Tomaske
- Department of Paediatrics, Triemli Hospital Zurich, Zurich, Switzerland
| | - Vincenzo Cannizzaro
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anna Steppacher
- Department of Paediatrics, Triemli Hospital Zurich, Zurich, Switzerland
| | - Franziska Zucol
- Paediatric Infectious Diseases, Department of Paediatrics, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Martin Theiler
- Paediatric Skin Centre, Department of Dermatology, University Children's Hospital Zurich, Zurich, Switzerland
| | | | | | - Philipp P Bosshard
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Patrick M Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
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Cao W, Thorpe PG, O'Callaghan K, Kersh EN. Advantages and limitations of current diagnostic laboratory approaches in syphilis and congenital syphilis. Expert Rev Anti Infect Ther 2023; 21:1339-1354. [PMID: 37934903 PMCID: PMC10958575 DOI: 10.1080/14787210.2023.2280214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/02/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION The reemergence of syphilis, especially congenital syphilis, presents a significant public health threat. Accurate diagnosis of syphilis depends on recognition of a constellation of symptoms, review of medical and sexual history, and multiple laboratory tests. While reliable, current tests for syphilis can be difficult to interpret, which can lead to delays in treatment. AREA COVERED This review summarizes the major advantages and limitations of available diagnostic laboratory methods for syphilis, provides an update on recent advances in laboratory tools, and highlights the urgent need for coordinated efforts to create new tools to halt the resurgence of syphilis. EXPERT OPINION In syphilis, the wide variety of short-lived signs and symptoms followed by periods of latency create diagnostic challenges. Currently available laboratory tests, when positive, require additional information to interpret (prior testing, treatment, and sexual history). Point-of-care tests that can rapidly and accurately detect both treponemal and non-treponemal antibodies would be a huge step toward reducing test turnaround time and time to treatment. Incorporating biological insights and technology innovations to advance the development of direct detection assays is urgently needed. A comprehensive coordinated effort is critical to stem the tide of rising syphilis in the United States and globally.
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Affiliation(s)
- Weiping Cao
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Phoebe G Thorpe
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kevin O'Callaghan
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ellen N Kersh
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Mischler-Gornostaeva K, Glatz M, Fehr J, Bosshard PP. Clinical presentation and serological diagnosis of syphilis reinfection in men living with HIV: a retrospective cohort study. Sex Transm Infect 2021; 98:341-345. [PMID: 34475233 DOI: 10.1136/sextrans-2020-054923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 08/20/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Studies on the characteristics of syphilis reinfection are scarce despite increasing numbers and proportions of cases. We aimed to gain insights into the clinical and serological presentation of reinfected men living with HIV and to evaluate diagnostic criteria for syphilis reinfection. METHODS We conducted a retrospective cohort study of 259 HIV-positive men diagnosed with syphilis between January 1999 and September 2015 at the University Hospital Zurich. We compared patients with a single syphilis infection (n=109) to patients with reinfections (n=150). RESULTS The two groups matched in age, sexual orientation and numbers of other STIs. Reinfected patients more often presented with latent syphilis than patients with a single syphilis episode (41.9% vs 8.9%; p<0.001). Although generally high venereal diseases research laboratory (VDRL) or rapid plasma reagin (RPR) titres (median 1:32) were seen in reinfected patients, 19.4% had titres ≤1:8. Treponema pallidum passive particle agglutination (TPPA) titres were significantly higher (1:81 840 vs 1:10 240; p<0.001), while IgM values were significantly lower (1.27 vs 3.5; p<0.001) in syphilis reinfections than in first infections. The TPPA increased ≥fourfold in >92.3% of reinfected patients. CONCLUSIONS Our data highlight the paramount importance of regularly screening patients at risk as syphilis reinfections in men living with HIV are more likely to be latent infections, that is, without symptoms. As non-treponemal tests might be biologically false-positive (up to a titre of 1:8) due to various conditions, a ≥fourfold increase of the TPPA might be considered as optional criterion for the diagnosis of syphilis reinfections. This could be especially valuable for diagnosing reinfected latent stage patients.
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Affiliation(s)
| | - Martin Glatz
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan Fehr
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Department of Public Health, University of Zurich, Zurich, Switzerland
| | - Philipp Peter Bosshard
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Abstract
We conducted a systematic review of relevant syphilis diagnostic literature to address the question, “What is the sensitivity and specificity of the treponemal tests currently approved by the Food and Drug Administration (FDA) for the diagnosis of syphilis (by stage)?” There were 16 treponemal assays evaluated: 13 immunoassays and 3 manual assays (fluorescent treponemal antibody absorbed test [FTA-ABS], microhemagglutination assay for Treponema pallidum antibodies [MHA-TP], Treponema pallidum particle agglutination assay [TP-PA]). MHA-TP and FTA-ABS were less sensitive in primary and secondary syphilis than TP-PA; TP-PA is the most specific manual treponemal assay. There is insufficient evidence to recommend one particular treponemal immunoassay (eg, enzyme immunoassays, chemiluminescence immunoassays, microbead immunoassays) over another based on published performance data. For diagnosis of neurosyphilis, cerebrospinal fluid (CSF) TP-PA has similar performance to CSF FTA-ABS in studies with patients with definitive or presumptive neurosyphilis. However, CSF treponemal testing has limitations in its sensitivity and specificity and should be interpreted within the context of the clinical scenario, additional CSF test results and syphilis prevalence.
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Affiliation(s)
- Ina U Park
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
- Correspondence: I. U. Park, Department of Family and Community Medicine, University of California San Francisco School of Medicine, Medical Consultant, Division of STD Prevention, Centers for Disease Control and Prevention, STD Control Branch, 850 Marina Bay Parkway, Building P, 2nd Floor, Richmond, CA 94804 ()
| | - Anthony Tran
- Public Health Laboratory, Department of Forensic Sciences, Washington, DC, USA
| | - Lara Pereira
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yetunde Fakile
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Abstract
We reviewed relevant syphilis diagnostic literature to address the question “What diagnostic considerations should be taken into account when screening for syphilis using the traditional or reverse algorithm?” Improved laboratory diagnosis of syphilis is an important element of the effort to reduce syphilis rates. Screening for syphilis is performed using either a nontreponemal or treponemal test (part of the traditional or reverse algorithm, respectively). Both syphilis algorithms are used by laboratories. However, there are limited data on the performance and cost-effectiveness of the algorithms. An expert panel generated “key questions” in the laboratory diagnosis of syphilis. This paper pertains to the key factors that should be considered when deciding whether to screen for syphilis using either the traditional or the reverse algorithm. A systematic literature review was performed, and tables of evidence were created to address this question.
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Affiliation(s)
- Daniel A Ortiz
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Mayur R Shukla
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Paparizos V, Tsimpidakis A, Nicolaidou E, Daskalakis E, Paparizou E, Vasalou V, Vrioni G, Rigopoulos D. Duration of anti-treponemal immunoglobulin M seroreversion after successful syphilis treatment in HIV-positive and -negative patients. Int J STD AIDS 2021; 32:523-527. [PMID: 33533297 DOI: 10.1177/0956462420980927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Treponemal immunoglobulin M (IgM) antibody detection is currently among serologic tests used for syphilis diagnosis. However, the exact role of these antibodies is unclear. In this retrospective study of 326 (198 HIV positive and 128 negative) patients with early syphilis and positive IgM serology, data were analysed to investigate the time of IgM seroreversion after treatment and correlation with covariate factors. Median time of IgM seroreversion in the study population was 9 months (range 3-84, interquartile range 5-12). No statistically significant difference was observed between HIV-positive and -negative patients. At 12 months, 80.1% of the patients had a negative IgM test. At 6 months, 100% of HIV-positive patients had a fourfold decrease or greater in Venereal Disease Research Laboratory titres, but only 35.4% had a negative treponemal IgM. Secondary and early latent stage patients had a slower seroreversion of IgM (Hazard Ratio (HR) = 0.73, p = 0.064 and HR = 0.60, p = 0.023, respectively) than those with primary syphilis. A very strong association was observed of time to seroreversion of treponemal IgM with baseline VDRL titre (p < 0.001). Treponemal IgM antibody detection often cannot distinguish between active and successfully treated syphilis. Treponemal IgM may only be useful in the cases recommended in the guidelines, and in cases of untreated syphilis, it could support but not confirm the diagnosis.
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Affiliation(s)
- Vasilios Paparizos
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
| | - Antonios Tsimpidakis
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
| | - Electra Nicolaidou
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
| | - Evangelos Daskalakis
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
| | - Eleni Paparizou
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
| | - Varvara Vasalou
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
| | - Georgia Vrioni
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
| | - Dimitris Rigopoulos
- First Department of Dermatology-Venereology of Athens Medical School, 58838Andreas Syngros Hospital, Athens, Greece
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Osbak KK, Tsoumanis A, De Baetselier I, Van Esbroek M, Smet H, Kenyon CR, Crucitti T. Role of IgM testing in the diagnosis and post-treatment follow-up of syphilis: a prospective cohort study. BMJ Open 2020; 10:e035838. [PMID: 32958482 PMCID: PMC7507855 DOI: 10.1136/bmjopen-2019-035838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The diagnosis of repeat syphilis and its follow-up remains challenging. We aimed to investigate if IgM testing may assist in the diagnosis of syphilis reinfection/relapse and its treatment follow-up. METHODS This substudy was conducted in the context of a syphilis biomarker discovery study (ClinicalTrials.gov Nr: NCT02059525). Sera were collected from 120 individuals with a new diagnosis of syphilis (72 with repeat infections) and 30 syphilis negative controls during a cohort study investigating syphilis biomarkers conducted at a sexually transmitted infection/HIV clinic in Antwerp, Belgium. Syphilis was diagnosed based on a simultaneous positive treponemal and non-treponemal assay result and/or positive serum PCR targeting polA. Specimens collected at visit of diagnosis, and 3 and 6 months post-treatment were tested by two enzyme immunoassays (EIAs), recomWell (Mikrogen; MI) and Euroimmun (EU), to detect anti-treponemal IgM. Baseline specimens were also tested for anti-treponemal IgM using a line immunoassay (LIA) recomLine (MI). Quantitative kinetic decay curves were constructed from the longitudinal quantitative EIA results. RESULTS An overall sensitivity for the diagnosis of syphilis of 59.8% (95% CI: 50.3%-68.7%), 75.0% (95% CI: 66.1%-82.3%) and 63.3% (95% CI: 54.8%-72.6%) was obtained for the EU, MI EIAs and MI LIA, respectively. When only considering repeat syphilis, the diagnostic sensitivity decreased to 45.7% (95% CI: 33.9%-58.0%), 63.9% (95% CI: 51.7%-74.6%) and 47.2% (95% CI: 35.5%-59.3%), respectively. IgM seroreverted in most cases 6 months after treatment. Post-treatment IgM concentrations decreased almost 30% faster for initial syphilis compared with repeat infection. The IgM EIAs and IgM LIA agreed from fairly to moderately (Cohen's kappa (κ): 0.36 (EU EIA); κ: 0.53 (MI EIA); κ: 0.40 (MI LIA)) with the diagnosis of syphilis. CONCLUSIONS IgM detection was not a sensitive method to diagnose syphilis and was even poorer in the diagnosis of syphilis repeat infections.
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Affiliation(s)
- Kara K Osbak
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Irith De Baetselier
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marjan Van Esbroek
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Hilde Smet
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Chris R Kenyon
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Medicine, Groote Schuur Hospital, Observatory, South Africa
| | - Tania Crucitti
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Kelly M, Hendry S, Norton R. The utility of the syphilis enzyme immunoassay IgM in the diagnosis of congenital syphilis. Diagn Microbiol Infect Dis 2020; 98:115152. [PMID: 32866939 DOI: 10.1016/j.diagmicrobio.2020.115152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/13/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Madeleine Kelly
- School of Medicine, James Cook University, Townsville, Queensland 4814, Australia
| | - Stephanie Hendry
- Pathology Queensland, Townsville Hospital, Townsville, Queensland 4814, Australia.
| | - Robert Norton
- Pathology Queensland, Townsville Hospital, Townsville, Queensland 4814, Australia
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Pastuszczak M, Kotnis-Gąska A, Jakubowicz B, Martyka I, Bociaga-Jasik M, Wojas-Pelc A. Utility of antitreponemal IgM testing in the diagnosis of early and repeat syphilis among HIV-infected and non-infected patients. Int J STD AIDS 2018; 29:890-894. [PMID: 29629652 DOI: 10.1177/0956462418762849] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Until now only non-treponemal tests (e.g. rapid plasma reagin [RPR]) have been used to monitor syphilis activity (e.g. distinguishing between treated, untreated and repeat disease) and efficacy of treatment. However, they usually require manual operation and are less specific than treponemal tests. The aim of the current study was to evaluate the use of the antitreponemal IgM testing in the diagnosis of early and repeat syphilis in HIV-infected and non-infected patients. One hundred and seventeen patients with early syphilis were included in this prospective study. RPR and anti- Treponema pallidum-IgM (TP-IgM) tests were conducted at onset and at three-month intervals during 24-month follow-up after initial treatment. In 31 of 117 syphilitic patients the co-occurrence of HIV infection was diagnosed. A positive TP-IgM test was present in 78.6% of patients with newly-diagnosed primary syphilis, 95.8% with secondary and 57.9% with early latent syphilis, but only in 38.5% patients with syphilis reinfection. There was a significant correlation between primary and secondary syphilis, higher baseline RPR titre and the pre-treatment IgM test reactivity. Regardless of the syphilis stage, HIV-seropositive individuals were more frequently positive for TP-IgM, both during the first onset of the disease (90.3%), and reinfection (71.4%), as compared to the HIV-seronegative group (71.4% and 0%, respectively, P < 0.03). TP-IgM seroreversion was observed in 115 out of 117 patients studied (98.3%) during follow-up (mean time to seroreversion 6.9 months). The time to TP-IgM seroreversion after treatment was significantly shorter in patients with early symptomatic syphilis (mean 4.9 months) when compared to early latent syphilis (7.7 months, P < 0.05). A negative TP-IgM test was found in approximately 20% and 40% of individuals with primary and early latent syphilis, respectively. The value of IgM testing in the diagnosis of syphilis reinfection is doubtful.
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Affiliation(s)
- Maciej Pastuszczak
- 1 Department of Dermatology, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | | | | | - Iwona Martyka
- 3 Department of Microbiology, University Hospital of Cracow, Cracow, Poland
| | - Monika Bociaga-Jasik
- 4 Department of Infectious Diseases, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Anna Wojas-Pelc
- 1 Department of Dermatology, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
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Zhang L, Deng M, Zhang X, Yin W, Liu W, Luo X, Yang J, Chen F, Zhao F. Serological evaluation of antigen Tp0693 for diagnosis of syphilis. Exp Ther Med 2017; 14:4729-4736. [PMID: 29201173 PMCID: PMC5704258 DOI: 10.3892/etm.2017.5158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 06/15/2017] [Indexed: 12/05/2022] Open
Abstract
The aim of the present study was to evaluate the diagnostic value of the Treponema pallidum (Tp) antigen Tp0693 for syphilis. ELISA was used to examine the serum levels of Tp0693. The sample-to-cutoff ratio (S/CO) value was used to generate a receiver operating characteristic (ROC) curve. A correlation analysis was performed to compare the detection efficacy of Tp0693-specific ELISA, Treponema pallidum Particle Agglutination (TPPA), Tolulized Red Unheated Serum test (TRUST) and LiZhu™ Tp-ELISA. The area under the ROC curve was 0.99, indicating good diagnostic efficacy. When the diagnostic specificity reached 100%, the diagnostic sensitivity was up to 93.5%. Tp0693-specific ELISA results were not correlated with those of TPPA, TRUST and LiZhu™ Tp-ELISA (correlation coefficient, 0.122, 0.114 and 0.025, respectively). The latent syphilis rate was highest (12%, 9/75) for all syphilis specimens with a S/CO in the grey area. In conclusion, for syphilis specimens with a S/CO in the grey area, TPPA should be used for further confirmation of the diagnosis. Tp0693 may be used as a diagnostic antigen for syphilis; however, further study regarding its potential use is required.
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Affiliation(s)
- Li Zhang
- Department of Laboratory, The First People's Hospital of Changde Affiliated to The University of South China, Changde, Hunan 415000, P.R. China
- Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Institute of Pathogenic Biology, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Meixia Deng
- Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Institute of Pathogenic Biology, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Xiaohong Zhang
- Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Institute of Pathogenic Biology, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Weiguo Yin
- Department of Laboratory, Yuebei People's Hospital, Shaoguan, Guangdong 512026, P.R. China
- Department of Molecular Biology Research Center, Qingyuan People's Hospital, Qingyuan, Guangdong 511500, P.R. China
| | - Wen Liu
- Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Institute of Pathogenic Biology, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Xi Luo
- Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Institute of Pathogenic Biology, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Jie Yang
- Department of Clinical Medicine, Medical College, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Fei Chen
- Department of Clinical Medicine, Medical College, University of South China, Hengyang, Hunan 421001, P.R. China
| | - Feijun Zhao
- Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Institute of Pathogenic Biology, University of South China, Hengyang, Hunan 421001, P.R. China
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Golušin Z, Jovanović M, Matić M, Vujanović L, Roš T, Jeremić B. Serological Tests for Acquired Syphilis in Immuno-competent Patients. Serbian Journal of Dermatology and Venereology 2017. [DOI: 10.1515/sjdv-2016-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Serological tests represent a valuable tool for the diagnosis and monitoring the syphilis treatment. Non-treponemal antibodies are nonspecific to detect the infection, but antibody titers are used to monitor the effects of syphilis treatment. A definitive diagnosis of syphilis is made using treponemal tests, because they detect specific antibodies to the treponemal strains or treponemal fragments, which cause syphilis. These tests may remain reactive for years, sometimes for life, regardless of the therapy outcome. Even after successful treatment, approximately 85% of patients remain positive for treponemal antibodies for the rest of their lives. However, treponemal tests cannot differentiate past infections from a current infection. Therefore, we use a combination of specific and non-specific tests, the two most frequently used diagnostic algorithms. The traditional algorithm begins with a non-treponemal assay, and if it is positive, the treponemal test is done. A positive treponemal test indicates syphilis. The reverse serology algorithm detects early, primary, and treated syphilis that may be missed with traditional screening. However, non-treponemal test is necessary to detect patients with active syphilis.
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Affiliation(s)
- Zoran Golušin
- Faculty of Medicine, University of Novi Sad, Serbia
- Clinic of Dermatovenereology Diseases, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Marina Jovanović
- Faculty of Medicine, University of Novi Sad, Serbia
- Clinic of Dermatovenereology Diseases, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Milan Matić
- Faculty of Medicine, University of Novi Sad, Serbia
- Clinic of Dermatovenereology Diseases, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Ljuba Vujanović
- Faculty of Medicine, University of Novi Sad, Serbia
- Clinic of Dermatovenereology Diseases, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Tatjana Roš
- Faculty of Medicine, University of Novi Sad, Serbia
- Clinic of Dermatovenereology Diseases, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Biljana Jeremić
- Faculty of Medicine, University of Novi Sad, Serbia
- Clinic of Dermatovenereology Diseases, Clinical Center of Vojvodina, Novi Sad, Serbia
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Jiang C, Xiao J, Xie Y, Xiao Y, Wang C, Kuang X, Xu M, Li R, Zeng T, Liu S, Yu J, Zhao F, Wu Y. Evaluation of FlaB1, FlaB2, FlaB3, and Tp0463 of Treponema pallidum for serodiagnosis of syphilis. Diagn Microbiol Infect Dis 2016; 84:105-11. [PMID: 26607421 DOI: 10.1016/j.diagmicrobio.2015.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 09/30/2015] [Accepted: 10/04/2015] [Indexed: 10/22/2022]
Abstract
Syphilis is a multistage disease caused by the invasive spirochete Treponema pallidum subsp. pallidum, and accurate diagnosis is important for the prevention and treatment of syphilis. Here, to identify appropriate diagnostic antigens for serodiagnosis of syphilis, 6 recombinant proteins were expressed in Escherichia coli and purified, including flagellins (FlaB1 [Tp0868], FlaB2 [Tp0792], and FlaB3 [Tp0870]), Tp0463, Tp0751, and Tp1038. The sensitivities were determined by screening sera from individuals with primary (n=82), secondary (n=115), latent (n=105), and congenital (n=65) syphilis. The specificities were determined by screening sera from uninfected controls (n=30) and potentially cross-reactive infections including Lyme disease (n=30), leptospirosis (n=5), and hepatitis B (n=30). Our data showed that FlaB1, FlaB2, FlaB3, Tp0463, and Tp1038 exhibited higher overall sensitivities and specificities for detecting IgG antibody, with 95.4% and 98.9%, 92.6% and 95.8%, 95.1% and 95.8%, 92.6% and 97.9%, and 95.9% and 98.9%, respectively. In contrast, Tp0751 demonstrated only an overall sensitivity of 39.2%. For comparison, the sensitivity and specificity of Architect Syphilis TP were determined to be 98.1% and 93.7%, respectively. In addition, FlaB1, FlaB2, FlaB3, and Tp0463 demonstrated excellent performance for detecting IgM antibody in primary and congenital syphilis, with sensitivities of 76.8% and 83.1%, 72.0% and 87.7%, 74.4% and 89.2%, and 64.6% and 75.3%, respectively. These results indicate that FlaB1, FlaB2, FlaB3, and Tp0463 could be as novel diagnostic candidates for serodiagnosis of syphilis.
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Malm K, Andersson S, Fredlund H, Norrgren H, Biague A, Månsson F, Ballard R, Unemo M. Analytical evaluation of nine serological assays for diagnosis of syphilis. J Eur Acad Dermatol Venereol 2015; 29:2369-76. [PMID: 26370737 DOI: 10.1111/jdv.13237] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/12/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The diagnosis of syphilis is most frequently dependent on antibody detection with serological assays. Assays for both treponemal and non-treponemal antibodies are needed to provide a sensitive and specific diagnosis. For decades, a first screening has been done with non-treponemal assays, followed by treponemal. However, in recent years, following laboratory automation, the reverse sequence screening algorithms have been developed, using a treponemal assay as the initial screening test. OBJECTIVE To evaluate serological assays for treponemal and non-treponemal antibodies, to use in reverse algorithm screening of syphilis. MATERIAL AND METHODS Six treponemal assays (one IgM-specific assay), two non-treponemal assays and one novel dual point-of-care (POC) assay for serological diagnosis of syphilis were evaluated. Serum samples from Guinea-Bissau and Sweden were examined, as well as two performance panels and samples from blood donors. Sensitivity and specificity were calculated for each assay, using different assays as gold standard test. RESULTS The Macro-Vue RPR Card test was the most sensitive non-treponemal test and the TrepSure Anti-Treponema EIA Screen and the SeroDia TP-PA were the most sensitive and specific treponemal assays. Among the automated assays, both the Liaison Treponema Screen and Architect Syphilis TP showed high sensitivity, however, the former had clearly higher specificity. CONCLUSIONS In resourced settings, where the reverse sequence algorithm is preferred for screening, an automated treponemal immunoassay for initial screening subsequently followed by the TrepSure test or TP-PA assay as a second treponemal assay appear highly effective. Finally, a quantitative highly sensitive non-treponemal assay, e.g. the Macro-Vue RPR Card test, could then be used as a supplementary test to evaluate activity of the syphilis infection.
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Affiliation(s)
- K Malm
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - S Andersson
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - H Fredlund
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - H Norrgren
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - A Biague
- National Public Health Laboratory (LNSP), Bissau, Guinea-Bissau
| | - F Månsson
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - R Ballard
- Center for Global Health, Centers for Disease Control and Protection, Atlanta GA, USA
| | - M Unemo
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Knauf S, Dahlmann F, Batamuzi EK, Frischmann S, Liu H. Validation of serological tests for the detection of antibodies against Treponema pallidum in nonhuman primates. PLoS Negl Trop Dis 2015; 9:e0003637. [PMID: 25803295 PMCID: PMC4372418 DOI: 10.1371/journal.pntd.0003637] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 02/22/2015] [Indexed: 01/06/2023] Open
Abstract
There is evidence to suggest that the yaws bacterium (Treponema pallidum ssp. pertenue) may exist in non-human primate populations residing in regions where yaws is endemic in humans. Especially in light of the fact that the World Health Organizaiton (WHO) recently launched its second yaws eradication campaign, there is a considerable need for reliable tools to identify treponemal infection in our closest relatives, African monkeys and great apes. It was hypothesized that commercially available serological tests detect simian anti-T. pallidum antibody in serum samples of baboons, with comparable sensitivity and specificity to their results on human sera. Test performances of five different treponemal tests (TTs) and two non-treponemal tests (NTTs) were evaluated using serum samples of 57 naturally T. pallidum-infected olive baboons (Papio anubis) from Lake Manyara National Park in Tanzania. The T. pallidum particle agglutination assay (TP-PA) was used as a gold standard for comparison. In addition, the overall infection status of the animals was used to further validate test performances. For most accurate results, only samples that originated from baboons of known infection status, as verified in a previous study by clinical inspection, PCR and immunohistochemistry, were included. All tests, TTs and NTTs, used in this study were able to reliably detect antibodies against T. pallidum in serum samples of infected baboons. The sensitivity of TTs ranged from 97.7-100%, while specificity was between 88.0-100.0%. The two NTTs detected anti-lipoidal antibodies in serum samples of infected baboons with a sensitivity of 83.3% whereas specificity was 100%. For screening purposes, the TT Espline TP provided the highest sensitivity and specificity and at the same time provided the most suitable format for use in the field. The enzyme immune assay Mastblot TP (IgG), however, could be considered as a confirmatory test.
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Affiliation(s)
- Sascha Knauf
- German Primate Center, Pathology Unit, Work Group Neglected Tropical Diseases, Göttingen, Germany
- * E-mail:
| | - Franziska Dahlmann
- German Primate Center, Pathology Unit, Work Group Neglected Tropical Diseases, Göttingen, Germany
| | - Emmanuel K. Batamuzi
- Sokoine University of Agriculture, Faculty of Veterinary Medicine, Department of Surgery and Theriogenology, Morogoro, Tanzania
| | | | - Hsi Liu
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Diseases Control and Prevention, Atlanta, Georgia, United States of America
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Glatz M, Juricevic N, Altwegg M, Bruisten S, Komericki P, Lautenschlager S, Weber R, Bosshard P. A multicenter prospective trial to asses a new real-time polymerase chain reaction for detection of Treponema pallidum, herpes simplex-1/2 and Haemophilus ducreyi in genital, anal and oropharyngeal ulcers. Clin Microbiol Infect 2014; 20:O1020-7. [DOI: 10.1111/1469-0691.12710] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 11/28/2022]
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