Improved rapid diagnostic tests to detect syphilis and yaws: a systematic review and meta-analysis

Abstract

BackgroundCurrent rapid tests for syphilis and yaws can detect treponemal and non-treponemal antibodies. We aimed to critically appraise the literature for rapid diagnostic tests (RDTs) which can better distinguish an active infection of syphilis or yaws.MethodsWe conducted a systematic review and meta-analysis, searching five databases between January 2010 and October 2021 (with an update in July 2022). A generalised linear mixed model was used to conduct a bivariate meta-analysis for the pooled sensitivity and specificity. Heterogeneity was assessed using the I2 statistic. We used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) to assess the risk of bias and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) to evaluate the certainty of evidence.ResultsWe included 17 studies for meta-analyses. For syphilis, the pooled sensitivity and specificity of the treponemal component were 0.93 (95% CI: 0.86 to 0.97) and 0.98 (95% CI: 0.96 to 0.99), respectively. For the non-treponemal component, the pooled sensitivity and specificity were 0.90 (95% CI: 0.82 to 0.95) and 0.97 (95% CI: 0.92 to 0.99), respectively. For yaws, the pooled sensitivity and specificity of the treponemal component were 0.86 (95% CI: 0.66 to 0.95) and 0.97 (95% CI: 0.94 to 0.99), respectively. For the non-treponemal component, the pooled sensitivity and specificity were 0.80 (95% CI: 0.55 to 0.93) and 0.96 (95% CI: 0.92 to 0.98), respectively.ConclusionsRDTs that can differentiate between active and previously treated infections could optimise management by providing same-day treatment and reducing unnecessary treatment.PROSPERO registration numberCRD42021279587.

The population-level impact of introducing rapid diagnostic tests on syphilis transmission in Canadian arctic communities – a mathematical modeling study

“…Rapid diagnostic tests can be used as a screening tool by non-laboratorians, in complementarity to the use of conventional laboratory assays. Although previous studies considered the “acceptable trade-off” of lower sensitivities of rapid diagnostic tests using whole blood sample in clinical settings for early diagnosis and treatment at the point-of-care, 43 our results indicate a minimal impact of increasing the sensitivity of rapid diagnostic tests on population-level transmission of syphilis. This can be explained by rapid diagnostic tests already achieving a high sensitivity for infectious syphilis when using whole blood samples and the fact that any false negative rapid diagnostic tests results would be confirmed positives with the conventional testing assays.…”

Sensitivity and specificity of a syphilis rapid diagnostic test in blood donors’ samples

“…In addition, results were not stratified by syphilis stages, which likely influence the overall performance of RDT. 6 Few studies have addressed the accuracy of syphilis RDT among people living with HIV; 7 this is a relevant issue since previous studies suggest higher risk of false-positive syphilis reactivity in this population using different diagnostic tools. 8 …”