Open Forum Infectious Diseases最新文献

{"title":"Tracking Extended-Spectrum Beta Lactamase-Producing <i>Enterobacterales</i> Across One Health Among Bedouin Communities.","authors":"Hillary A Craddock, Keren Anat Resnick, Orel Gorovsky, Ikram Salah, Mustafa Abu Ramileh, Lior Nesher, Yael Yagel, Orli Sagi, Shani Troib, Yair Motro, Jacob Moran-Gilad","doi":"10.1093/ofid/ofaf495","DOIUrl":"10.1093/ofid/ofaf495","url":null,"abstract":"<p><p><i><b>Background.</b></i> Health inequality is an important determinant of antimicrobial resistance (AMR), which is often understudied. The objective of this study was to investigate extended-spectrum beta lactamase-producing (ESBL-P) <i>Enterobacterales</i> from a One Health perspective (holistically approaching human, animal, and environmental health as linked), among the Bedouin, an indigenous pastoralist community. <i><b>Methods.</b></i> Extended-spectrum beta lactamase-producing isolates from clinical urinary samples (n = 98), greywater (n = 47), sewage (n = 11), surface water (n = 24), animal fecal (n = 9), and milk (n = 1) were subject to phenotypic testing using VITEK-2 and short-read sequencing followed by analyses of resistomes, mobilomes, and phylogeny. <i><b>Results.</b></i> Extended-spectrum beta lactamase-producing isolates from diverse sources, mainly <i>Escherichia coli</i> and <i>Klebsiella</i> sp., exhibited a wide range of significant antibiotic resistance genes (ARGs) with <i>bla</i>CTX-M as the key ESBL gene. High-risk clones (eg, ST131 and ST38) were noted, most commonly among environmental and clinical <i>E. coli</i> isolates. Environmental and clinical isolates exhibited potential relatedness, despite coming from different locations and sample types. Most predicted plasmids were <i>lnc</i>-type and harbored at least one beta-lactamase gene, including <i>bla</i>CTX-M-15. <i><b>Conclusions.</b></i> Extended-spectrum beta lactamase-producing isolates from the living environment of Bedouins exhibited a wide range of ARGs of public health interest. Environment-human and environment-animal clusters of isolates and plasmids were identified. Further research is needed to establish the transmission dynamics of AMR and related mobile elements across One health in this setting and related risks.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 9","pages":"ofaf495"},"PeriodicalIF":3.8,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glycopeptide Heteroresistance Among Coagulase-Negative Staphylococci: A Systematic Review and Meta-analysis.","authors":"Clark D Russell, Min Ke, Simon Dewar, Naomi J Gadsby, Ewan S Olson, Mandy Wootton","doi":"10.1093/ofid/ofaf494","DOIUrl":"10.1093/ofid/ofaf494","url":null,"abstract":"<p><p>We identified a high prevalence of glycopeptide heteroresistance amongst coagulase-negative staphylococci (41.4%, 95% confidence interval 30.7-52.9; meta-analysis including n = 1432 isolates). Heteroresistance was associated with methicillin resistance, did not require glycopeptide exposure, and may be more prevalent among isolates from invasive infections. Heteroresistance may represent an under-appreciated reason for treatment failure of CoNS infections.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 8","pages":"ofaf494"},"PeriodicalIF":3.8,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bacteremic vs Nonbacteremic <i>Shigella</i> Infections in the United States Veterans Health Administration, 2000-2024.","authors":"Gina Oda, Joyce Chung, Cynthia Lucero-Obusan, Mark Holodniy","doi":"10.1093/ofid/ofaf488","DOIUrl":"10.1093/ofid/ofaf488","url":null,"abstract":"<p><strong>Background: </strong>Risk factors for <i>Shigella</i> bacteremia are poorly understood. Growing trends in antimicrobial resistance may make treatment of <i>Shigella</i> bacteremia more difficult. We identified risk factors for <i>Shigella</i> bacteremia among <i>Shigella</i> cases who received care in the US Veterans Health Administration (VHA).</p><p><strong>Methods: </strong>We identified adults cared for in VHA with <i>Shigella</i> infection from 2000 to 2024. <i>Shigella</i> bacteremic versus nonbacteremic infections were compared based on patient demographics, comorbidities, outcomes, <i>Shigella</i> species, and antimicrobial resistance. We performed log-binomial regression analysis to estimate association of risk factors with <i>Shigella</i> bacteremia.</p><p><strong>Results: </strong>Of a total of 1962 <i>Shigella</i> infections in 1861 unique patients, 34 (1.7%) had confirmed bacteremia when blood cultures were checked. <i>Shigella</i> species among bacteremia cases included 13 (38.2%) <i>Shigella flexneri</i> and 14 (41.2%) <i>Shigella sonnei</i>, and 7 (2.6%) <i>Shigella</i> nonspeciated. A total of 1266/1962 (64.5%) isolates were tested for antimicrobial susceptibility. No <i>Shigella</i> bacteremia isolates were multidrug resistant; however, isolates from 3 nonbacteremic cases were. All with <i>Shigella</i> bacteremia were hospitalized and 1/34 (2.9%) died within 30 days of infection. Comparing characteristics of patients with <i>Shigella</i> bacteremic versus nonbacteremic infections and adjusting for potential confounders, age ≥65 years and HIV were independent risk factors for <i>Shigella</i> bacteremia (adjusted risk ratio [95% confidence interval] 2.90 [1.46-5.76] and 2.37 [1.11-5.06], respectively).</p><p><strong>Conclusions: </strong>Clinicians should be aware that patients who are elderly and/or have HIV are at higher risk for <i>Shigella</i> bacteremia and that these infections can be severe, requiring hospitalization. At this time, multidrug resistant <i>Shigella</i> strains have not been detected among bacteremic patients in VHA.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 9","pages":"ofaf488"},"PeriodicalIF":3.8,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations Between Environmental Conditions and Infection With Respiratory Syncytial Virus in Japan: A Spatiotemporal Analysis.","authors":"Jingyi Liang, Saturnino Luz, You Li, Harish Nair","doi":"10.1093/ofid/ofaf392","DOIUrl":"10.1093/ofid/ofaf392","url":null,"abstract":"<p><strong>Background: </strong>Respiratory syncytial virus (RSV) poses a significant disease burden among children <5 worldwide. Yet systematic analyses of how complex environmental factors are associated with RSV transmission are still lacking in many countries.</p><p><strong>Methods: </strong>We introduced a novel 3-stage, data-driven framework to assess the impacts of environmental factors, including meteorological conditions, air pollutants, and extreme weather, on RSV infections from a spatiotemporal perspective. It includes (1) spatiotemporal patterns of RSV transmission; (2) a hierarchical model (HSDLNM) to examine associations between environmental factors and RSV transmission, estimating relative risks (RRs) and 95% confidence intervals; and (3) an interpretable machine learning model, Gaussian Process Boosting, to predict RSV infections using historical environmental data. We validated the applicability of the proposed framework in Japan.</p><p><strong>Results: </strong>Weekly data on the number of newly lab-confirmed RSV-positive cases, meteorological factors, and air pollutants were collected from 47 Japanese prefectures (2013-2019). We identified the meteorological thresholds strongly linked to elevated RSV infections, particularly weekly average temperature <10°C (RR, 1.10) or >20°C (RR, 1.13) and weekly average relative humidity <60% (RR, 1.04) or >70% (RR, 1.06). Short-term exposure to particulate matter of 2.5 <math><mrow><mi>μ</mi> <mi>m</mi> <mspace></mspace></mrow> <mo>(</mo> <mrow><mrow><mi>P</mi></mrow> <msub><mrow><mi>M</mi></mrow> <mrow><mn>2.5</mn></mrow> </msub> </mrow> <mo>)</mo></math> is associated with elevated infection risk. Additionally, historical environmental data aid in forecasting RSV activities in Japan.</p><p><strong>Conclusions: </strong>This study presents the relationships between environmental factors and RSV infections in Japan. Our framework could be applied to areas with similar RSV seasonality to further understand environmental impacts regionally. This research helps inform policy decisions on RSV prophylaxis strategies, supporting cost-effective measures for controlling and preventing early transmission.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 8","pages":"ofaf392"},"PeriodicalIF":3.8,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12345628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144848184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Differences in Clinical Outcomes and Surgical Interventions for Infective Endocarditis: A Nationwide Registry.","authors":"Ching-Yi Lin, Feng-Cheng Chang, Chun-Yu Chen, Yu-Ting Cheng, Chia-Pin Lin, Ming-Jer Hsieh, Yi-Hsin Chan, Victor Chien-Chia Wu, An-Hsun Chou, Shao-Wei Chen","doi":"10.1093/ofid/ofaf473","DOIUrl":"10.1093/ofid/ofaf473","url":null,"abstract":"<p><strong>Background: </strong>Sex differences in infective endocarditis (IE) remain underexplored in large-scale studies. Current findings on clinical outcomes, particularly in surgical IE, are inconsistent, highlighting critical knowledge gaps.</p><p><strong>Methods: </strong>We conducted a nationwide cohort study using the Taiwan National Health Insurance Research Database (2001-2022) and a total of 28 976 adults with IE were identified. Subgroup analysis focused on 4133 patients undergoing valve surgery. Primary outcomes included in-hospital mortality and long-term survival, analyzed using logistic regression and Cox models.</p><p><strong>Results: </strong>Of 28 976 patients, 4133 underwent surgery (women/men: 10 580/18 396 overall; 1252/2881 surgical). Women were older with more comorbidities. After propensity score matching, women had higher in-hospital mortality in both the general cohort (21.2% vs 19.8%; odds ratio [OR]: 1.09, 95% confidence interval [CI]: 1.02-1.17) and surgical subgroup (20.7% vs 13.3%; OR: 1.70, 95% CI: 1.37-2.11). Women undergoing surgery had more perioperative complications, including postcardiotomy cardiogenic shock (10.5% vs 7.8%) and de novo dialysis (13.5% vs 9.8%). Long-term mortality was lower in women, while women in the surgical subgroup had higher mortality (hazard ratio [HR]: 1.12, 95% CI: 1.01-1.25) and redo valve surgery rates (11.5% vs 8.1%; HR: 1.43; 95% CI: 1.07-1.90).</p><p><strong>Conclusions: </strong>Women with IE had higher in-hospital mortality regardless of surgical intervention. Among those who underwent surgery, women experienced more perioperative complications compared with men. Although women exhibited superior overall late survival, those undergoing surgery had worse long-term outcomes. These findings highlight the need for improved sex-specific management, including early diagnosis, timely surgery, and extended follow-up.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 8","pages":"ofaf473"},"PeriodicalIF":3.8,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12372668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trapped Below: Abdominal Pseudocysts Associated With Ventriculoperitoneal Shunts in Coccidioidal Meningitis.","authors":"Geetha Sivasubramanian","doi":"10.1093/ofid/ofaf486","DOIUrl":"10.1093/ofid/ofaf486","url":null,"abstract":"<p><p>Ventriculoperitoneal (VP) shunts are the mainstay for cerebrospinal fluid diversion in patients with refractory coccidioidal meningitis (CM)-associated hydrocephalus. Abdominal pseudocysts (APCs), an uncommon but known complication of distal shunt catheters, have not been well described in CM. We conducted a retrospective study of 124 patients with CM who underwent VP shunt placement between 2010 and 2024. APCs occurred in 21 patients (17%), with most presenting with symptoms of shunt malfunction rather than abdominal complaints. This incidence is notably higher than previously reported in patients with hydrocephalus due to other etiologies. Evidence of active <i>Coccidioides</i> infection was present in 71% of patients. Imaging typically revealed fluid collections at the distal catheter tip, and most patients underwent surgical intervention targeting the distal shunt. Despite intervention, recurrent shunt failures occurred in a substantial proportion. These findings add to the limited literature on APCs in CM and may inform future research into their presentation, contributing factors, and management.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 8","pages":"ofaf486"},"PeriodicalIF":3.8,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward Integrated Models of Infectious Diseases, Harm Reduction, and Primary Care.","authors":"Suhanee Mitragotri, Aakash Reddy, Kevan Shah, David T Zhu","doi":"10.1093/ofid/ofaf484","DOIUrl":"10.1093/ofid/ofaf484","url":null,"abstract":"","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 9","pages":"ofaf484"},"PeriodicalIF":3.8,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12396929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid, Amplification-free, RNA-based Uropathogen Detection With LbuCas13a.","authors":"Hirotaka Ata, Madeleine E Hull, William M Geisler, Sixto M Leal, Ashutosh Chilkoti","doi":"10.1093/ofid/ofaf477","DOIUrl":"10.1093/ofid/ofaf477","url":null,"abstract":"<p><strong>Background: </strong>Expeditious identification of bacterial infection remains an important challenge in an emergency department. Bacterial cultures remain the gold standard, though they take 24-72 hours to result. Polymerase chain reaction-based diagnostics are emerging but take several hours to get a result. Here, we report a rapid bacterial RNA detection platform based on Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) technology with urine-to-result time within 1 hour.</p><p><strong>Methods: </strong>All CRISPR experiments were conducted as an open format plate reader assay with fluorescent readouts. In derivation studies, <i>Escherichia coli</i> 16s rRNA was spiked in commercially purchased human urine to determine assay compatibility and limit of detection. In validation studies, previously collected, patient-derived raw urine was used to examine the assay concordance with urinary tract infection (UTI) diagnosis (N = 14).</p><p><strong>Results: </strong>The lower limit of detection of our CRISPR assay was ∼10⁶ copies/µL in human urine. In validation studies, the overall sensitivity was 75% for Gram-negative and Gram-positive UTIs combined. When performed postanalytically to conventional urinalysis, the combined diagnostic schema had 100% specificity and positive predictive value. Overall urine-to-result time was less than 1 hour.</p><p><strong>Conclusions: </strong>We demonstrated the feasibility to adopt an amplification-free CRISPR assay for the purpose of rapid uropathogen detection. To our knowledge, this is the first demonstration of an RNA-based tool for detecting uropathogens. Our assay may be used postanalytically to conventional urinalysis for improved specificity to diagnose UTIs. Future research may focus on improving the sensitivity and discriminating uropathogen versus bacterial contaminant, which is beyond the scope of the current study.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 8","pages":"ofaf477"},"PeriodicalIF":3.8,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12391756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardized Infliximab Regimen to Treat Severe Central Nervous System Tuberculosis: A Case Series of 18 Patients.","authors":"Johan Benhard, Gentiane Monsel, Vincent Dubée, Patricia Pavese, Vero Rasoldier, Valérie Garrait, Marie Talleux, Fanny Vuotto, Romain Gueneau, Xavier Pouget-Abadie, Michael Thy, Christia Palacios, Marwa Bachir, Felix Djossou, Simone Tunesi, Mathilde Fréchet Jachym, Valérie Pourcher, Nicolas Veziris, Anne Bourgarit","doi":"10.1093/ofid/ofaf450","DOIUrl":"10.1093/ofid/ofaf450","url":null,"abstract":"<p><strong>Background: </strong>Morbidity associated with central nervous system tuberculosis (CNS TB) remains high due to persistent inflammation despite standard-of-care (SOC) treatment, including antituberculosis therapy and corticosteroids. Tumor necrosis factor alpha (TNF-α) is a key cytokine driving this inflammatory response, and a limited number of case reports suggest that TNF-α inhibitors may improve outcomes. We report the 1-year outcome of a cohort of consecutive patients treated with infliximab for severe CNS TB.</p><p><strong>Methods: </strong>Following the guidance provided by the French Tuberculosis Consilium, a standardized regimen of intravenous infliximab at 5 mg/kg per dose was used to treat CNS TB unresponsive to SOC. We retrospectively included consecutive patients who received at least 1 infliximab injection for CNS TB from 2017 to September 2021.</p><p><strong>Results: </strong>Eighteen patients with CNS TB, 94% with tuberculous meningitis, were included. Most had severe disease: 82% were classified as British Medical Research Council grade II or III, and 44% required intensive care unit admission. All demonstrated clinical and radiological worsening despite SOC; in 89% due to paradoxical reaction. At infliximab initiation, symptoms remained disabling, with a median modified Rankin scale (mRS) score of 3.5 (interquartile range, 3-4). One month after the first infusion, 38% showed improved mRS scores, increasing to 78% at 1 year. One-year survival was 94%; 1 death occurred 12 months after a single infliximab dose and was unrelated to TB treatment.</p><p><strong>Conclusions: </strong>Infliximab may represent a promising adjunctive treatment for CNS TB unresponsive to SOC, including paradoxical reaction. Prospective studies are needed to confirm these findings.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 8","pages":"ofaf450"},"PeriodicalIF":3.8,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12351261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Proportion of <i>Treponema pallidum</i> Polymerase Chain Reaction-Positive Primary Syphilis Infections That Are Seronegative for Syphilis: A Systematic Review and Meta-analysis.","authors":"Yasmin Hughes, Janet M Towns, Jason J Ong, Eric P F Chow, Christopher K Fairley, Deborah A Williamson, Jade Bilardi, Jane S Hocking, Shivani Pasricha, Eloise Williams, Francesca Azzato, Marcus Y Chen","doi":"10.1093/ofid/ofaf471","DOIUrl":"10.1093/ofid/ofaf471","url":null,"abstract":"<p><strong>Background: </strong>Earlier syphilis detection is needed to reduce infectiousness and transmission and to improve control. Polymerase chain reaction (PCR) for <i>Treponema pallidum</i> is highly sensitive for detecting primary syphilis but is not often widely available or used. The aim of this systematic review and meta-analysis was to investigate the proportion of PCR-positive, seronegative primary syphilis infections when serology was performed at clinical presentation.</p><p><strong>Methods: </strong>We undertook a systematic review and meta-analysis to identify studies of patients presenting with primary syphilis where <i>T pallidum</i> PCR was performed on the primary syphilis lesion and serology for syphilis was performed on the same occasion. The review was conducted according to the Cochrane protocol. Medline, Embase, and PubMed were searched from 1 January 2000 to 27 November 2022 (date of search). Only studies published in English were included. A pooled estimate of the proportion of PCR-positive, seronegative primary infections was calculated via a random effects model.</p><p><strong>Results: </strong>Of 2571 studies identified, 8 met inclusion criteria and were included. This contributed to 758 individuals with <i>T pallidum</i> PCR<i>-</i>positive primary lesions who had serology performed at the same initial visit. Among these, a pooled estimate of 10% (95% CI, 6%-13%; 73/758; <i>I</i> ² = 65%, <i>P</i> < .01) was negative on all serologic markers, ranging between 4% (95% CI, 0%-7%; 4/108) and 20% (95% CI, 10%-29%; 14/71).</p><p><strong>Conclusions: </strong><i>T pallidum</i> was detected by PCR in 10% cases, which would have been missed if serology alone was used. <i>T pallidum</i> PCR is important for optimizing early detection of primary syphilis.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 9","pages":"ofaf471"},"PeriodicalIF":3.8,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}