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Flipse J, Niekamp AM, Dirks A, Dukers-Muijrers NHTM, Hoebe CJPA, Wolffs P, van Loo IHM. Refining Timely Diagnosis of Early Syphilis by Using Treponema pallidum PCR or IgM Immunoblotting Next to Conventional Serology for Syphilis. J Clin Microbiol 2023; 61:e0011223. [PMID: 37222630 PMCID: PMC10281170 DOI: 10.1128/jcm.00112-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
Treponema pallidum subsp. pallidum is a fastidious spirochete and the etiologic agent of syphilis, a sexually transmitted infection (STI). Syphilis diagnoses and disease staging are based on clinical findings and serologic testing. Moreover, according to most international guidelines, PCR analysis of swab samples from genital ulcers is included in the screening algorithm where possible. It has been suggested that PCR might be omitted from the screening algorithm due to low added value. As an alternative to PCR, IgM serology might be used. In this study, we wanted to establish the added value of PCR and IgM serology for diagnosing primary syphilis. Added value was defined as finding more cases of syphilis, preventing overtreatment, or limiting the extent of partner notification to more recent partners. We found that both PCR and IgM immunoblotting could aid the timely diagnosis of early syphilis in ~24% to 27% of patients. PCR has the greatest sensitivity and can be applied to cases with an ulcer with suspected reinfection or primary infection. In the absence of lesions, the IgM immunoblot could be used. However, the IgM immunoblot has better performance in cases with suspected primary infection than in reinfections. The target population, testing algorithm, time pressures, and costs should determine whether either test provides sufficient value to be implemented in clinical practice.
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Affiliation(s)
- Jacky Flipse
- Department of Medical Microbiology, Infectious Diseases, and Infection Prevention, Maastricht University Medical Centre, Care and Public Health Research Institute, Maastricht, the Netherlands
| | - Anne-Marie Niekamp
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, Public Health Service South Limburg, Heerlen, the Netherlands
- Department of Social Medicine, Maastricht University, Care and Public Health Research Institute, Maastricht, the Netherlands
| | - Anne Dirks
- Department of Medical Microbiology, Infectious Diseases, and Infection Prevention, Maastricht University Medical Centre, Care and Public Health Research Institute, Maastricht, the Netherlands
| | - Nicole H. T. M. Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, Public Health Service South Limburg, Heerlen, the Netherlands
- Department of Health Promotion, Maastricht University, Care and Public Health Research Institute, Maastricht, the Netherlands
| | - Christian J. P. A. Hoebe
- Department of Medical Microbiology, Infectious Diseases, and Infection Prevention, Maastricht University Medical Centre, Care and Public Health Research Institute, Maastricht, the Netherlands
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, Public Health Service South Limburg, Heerlen, the Netherlands
- Department of Social Medicine, Maastricht University, Care and Public Health Research Institute, Maastricht, the Netherlands
| | - Petra Wolffs
- Department of Medical Microbiology, Infectious Diseases, and Infection Prevention, Maastricht University Medical Centre, Care and Public Health Research Institute, Maastricht, the Netherlands
| | - Inge H. M. van Loo
- Department of Medical Microbiology, Infectious Diseases, and Infection Prevention, Maastricht University Medical Centre, Care and Public Health Research Institute, Maastricht, the Netherlands
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Chambers LC, Srinivasan S, Lukehart SA, Ocbamichael N, Morgan JL, Lowens MS, Fredricks DN, Golden MR, Manhart LE. Primary Syphilis in the Male Urethra: A Case Report. Clin Infect Dis 2020; 68:1231-1234. [PMID: 30202933 DOI: 10.1093/cid/ciy771] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 09/05/2018] [Indexed: 01/05/2023] Open
Abstract
We documented urethral Treponema pallidum infection in a man with nongonococcal urethritis and a negative syphilis serology using broad-range bacterial polymerase chain reaction (PCR) and sequencing, targeted PCR, and immunofluorescence microscopy. He subsequently seroconverted for syphilis. Early syphilis may present as urethritis. Urethral T. pallidum shedding can occur before seroconversion.
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Affiliation(s)
| | | | - Sheila A Lukehart
- Department of Medicine, University of Washington.,Department of Global Health, University of Washington
| | | | | | - M Sylvan Lowens
- Public Health-Seattle & King County HIV/STD Program, Washington
| | - David N Fredricks
- Fred Hutchinson Cancer Research Center.,Department of Medicine, University of Washington
| | - Matthew R Golden
- Department of Medicine, University of Washington.,Public Health-Seattle & King County HIV/STD Program, Washington
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Roberts CP, Klausner JD. Global challenges in human immunodeficiency virus and syphilis coinfection among men who have sex with men. Expert Rev Anti Infect Ther 2016; 14:1037-1046. [PMID: 27626361 DOI: 10.1080/14787210.2016.1236683] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Syphilis and human immunodeficiency virus (HIV) coinfection disproportionately affects men who have sex with men (MSM), and the rate of coinfection has been increasing over the last decade. HIV and syphilis coinfection is particularly challenging because the infections interact synergistically thereby increasing the risk of acquisition and transmission as well as accelerating disease progression. Areas covered: This paper reviews and summarizes the epidemiology, pathogenesis, diagnosis, clinical management and prevention of HIV and syphilis coinfection among MSM. Expert commentary: Research does not support a different syphilis treatment for coinfected individuals; however, coinfection may warrant a recommendation for antiretroviral therapy. In order to reverse the epidemic of syphilis and HIV coinfection, there needs to be greater awareness, improved cultural sensitivity among health care providers, improved access to preventative services and increased screening for syphilis and HIV.
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Affiliation(s)
- Chelsea P Roberts
- a David Geffen School of Medicine , University of California Los Angeles , Los Angeles , CA , USA
| | - Jeffrey D Klausner
- a David Geffen School of Medicine , University of California Los Angeles , Los Angeles , CA , USA.,b Division of Infectious Diseases, Department of Medicine , University of California, Los Angeles , Los Angeles , CA , USA
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