Performance of the nontreponemal tests and treponemal tests on cerebrospinal fluid for the diagnosis of neurosyphilis: A meta-analysis

Abstract

BackgroundNontreponemal and treponemal tests for analyzing cerebrospinal fluid to confirm the existence of neurosyphilis have been widely used, so we aim to evaluate and compare their performance on the cerebrospinal fluid in the diagnosis of neurosyphilis.MethodsWe conducted a systematic literature search on five databases and utilized a bivariate random-effects model to perform the quantitative synthesis.ResultsNontreponemal tests demonstrated a pooled sensitivity of 0.77 (95% CI: 0.68–0.83), a pooled specificity of 0.99 (95% CI: 0.97–1.00), and a summary AUC of 0.97 (95% CI: 0.95–0.98). The pooled sensitivity, pooled specificity, and summary AUC of treponemal tests were 0.95 (95% CI: 0.90–0.98), 0.85 (95% CI: 0.67–0.94), and 0.97 (95% CI: 0.95–0.98), respectively. The pooled specificity of all nontreponemal tests varied minimally (ranging from 0.97 to 0.99), with TRUST (0.83) having a higher pooled sensitivity than VDRL (0.77) and RPR (0.73). Among all treponemal tests, EIA has outstanding diagnostic performance with a pooled sensitivity of 0.99 and a pooled specificity of 0.98.ConclusionNontreponemal tests exhibited a higher pooled specificity, and treponemal tests exhibited a higher pooled sensitivity in diagnosing neurosyphilis on cerebrospinal fluid. TRUST may be a satisfactory substitute for VDRL. EIA is a prospective diagnostic tool that deserves further study in the future. Our study may be useful to clinical laboratories in selecting appropriate serological tests on the cerebrospinal fluid for the diagnosis of neurosyphilis.

Cerebrospinal fluid CXCL13 concentration for diagnosis of neurosyphilis: a systematic review and meta-analysis

“…Based on the meta-analysis of all the data, we set the pretest probability of the prevalence of neurosyphilis as 20%. 21 According to the Fagan plot analysis, the positive post-test probabilities increased to 53%, while the negative post-test probabilities decreased to 7% ( online supplemental figure 4 ).…”

Neutrophil CD64 index as a potential blood biomarker for the diagnosis of neurosyphilis in secondary and tertiary syphilis: A retrospective study

“…At present, the most used indicators were serum and CSF anti-TP antibodies, CSF WBC and CSF protein levels [ 23 , 24 ]. However, there are NS patients with negative CSF TRUST/VDRL [ 25 ] and asymptomatic NS patients who do not accept the lumbar puncture for the consideration of its invasiveness and safety. Therefore, lots of researchers turn to explore new biomarkers in blood.…”

Neurosyphilis: insights into its pathogenesis, susceptibility, diagnosis, treatment, and prevention

“…Previous studies have indicated that non-treponemal tests, such as the rapid plasma reagin (RPR) test, and toluidine red unheated serum test (TRUST), have stronger specificity than treponemal tests in the diagnosis of neurosyphilis ( 66 ). This may be explained by the fact that blood-derived anti-treponemal IgG antibodies can cross through the BBB and enter the CSF, thus leading to false-positive results ( 67 ).…”