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
{"title":"梅毒螺旋体聚合酶链反应阳性的原发性梅毒感染血清梅毒阴性的比例:一项系统回顾和荟萃分析","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":null,"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> <sup>2</sup> = 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":3.8000,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461845/pdf/","citationCount":"0","resultStr":"{\"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\":null,\"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> <sup>2</sup> = 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\":3.8000,\"publicationDate\":\"2025-08-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461845/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Open Forum Infectious Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ofid/ofaf471\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/9/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Open Forum Infectious Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ofid/ofaf471","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/9/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
The Proportion of Treponema pallidum Polymerase Chain Reaction-Positive Primary Syphilis Infections That Are Seronegative for Syphilis: A Systematic Review and Meta-analysis.
Background: Earlier syphilis detection is needed to reduce infectiousness and transmission and to improve control. Polymerase chain reaction (PCR) for Treponema pallidum 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.
Methods: We undertook a systematic review and meta-analysis to identify studies of patients presenting with primary syphilis where T pallidum 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.
Results: Of 2571 studies identified, 8 met inclusion criteria and were included. This contributed to 758 individuals with T pallidum PCR-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; I2 = 65%, P < .01) was negative on all serologic markers, ranging between 4% (95% CI, 0%-7%; 4/108) and 20% (95% CI, 10%-29%; 14/71).
Conclusions: T pallidum was detected by PCR in 10% cases, which would have been missed if serology alone was used. T pallidum PCR is important for optimizing early detection of primary syphilis.
期刊介绍:
Open Forum Infectious Diseases provides a global forum for the publication of clinical, translational, and basic research findings in a fully open access, online journal environment. The journal reflects the broad diversity of the field of infectious diseases, and focuses on the intersection of biomedical science and clinical practice, with a particular emphasis on knowledge that holds the potential to improve patient care in populations around the world. Fully peer-reviewed, OFID supports the international community of infectious diseases experts by providing a venue for articles that further the understanding of all aspects of infectious diseases.