Specific and sensitive diagnosis of syphilis using a real-time PCR for Treponema pallidum

Koek, Alex; Bruisten, Sylvia M.; Dierdorp, Mirjam; Dam, Alje P. van; Templeton, Kate

doi:10.1111/j.1469-0691.2006.01566.x

Cited by 57 publications

(42 citation statements)

References 11 publications

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“…The advantages of a real-time PCR are the ability to detect the pathogen directly, the short turnaround time, and the ease of performance. We previously developed a real-time PCR that targets the polA gene and that is performed with swabs from the (ano)genital ulceration(s) (10).…”

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confidence: 99%

Clinical Value of Treponema pallidum Real-Time PCR for Diagnosis of Syphilis

et al. 2010

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The diagnosis of syphilis can be complicated when it is based on diverse clinical manifestations, dark-field microscopy, and serology. In the present study, therefore, we examined the additional clinical value of a Treponema pallidum real-time TaqMan PCR for the detection of primary and secondary syphilis. The additional value of the T. pallidum real-time PCR for the diagnosis of primary syphilis was evaluated by the use of three different algorithms: (i) a head-to-head comparison of the dark-field microscopy result and the T. pallidum real-time PCR result, (ii) comparison of the clinical diagnosis made in a sexually transmitted infection clinic (STI) (including by dark-field microscopy) and the T. pallidum real-time PCR result, and (iii) comparison of the clinical diagnosis made in a general practitioner's office (without dark-field microscopy) and the T. pallidum real-time PCR result. A fourth algorithm was used to determine the performance of the T. pallidum real-time PCR regarding the detection of secondary syphilis. From December 2006 to April 2008, 716 patients with suspected cases of primary syphilis and 133 patients with suspected cases of secondary syphilis were included in the study. A kappa value of 0.601 was found for the agreement between dark-field microscopy and the T. pallidum real-time PCR. Good agreement was found between the T. pallidum real-time PCR and both the diagnosis of the general practitioner (kappa ‫؍‬ 0.745) and the diagnosis of the STI clinic (kappa ‫؍‬ 0.769). The sensitivity with respect to the STI clinic diagnosis was 72.8%, the specificity was 95.5%, the positive predictive value was 89.2%, and the negative predictive value was 95.0%. The T. pallidum real-time PCR is a fast, efficient, and reliable test for the diagnosis of primary syphilis in an STI outpatient clinic and a general practitioner setting, but it has no added diagnostic value for the diagnosis of secondary syphilis.The etiologic agent of syphilis, Treponema pallidum subsp. pallidum, causes a multistage sexually transmitted infection (STI). During the last decade, there has been an increase in the reported incidence of syphilis in industrialized countries, emphasizing the need for reliable diagnostics for syphilis.The slow generation time and the inability to survive and multiply outside the mammalian body make T. pallidum unsuitable for in vitro culturing (11). The reliable and fast diagnosis of syphilis and early treatment could improve public health. Until recently, the laboratory diagnosis of syphilis was based on dark-field microscopy and/or syphilis serology. Darkfield microscopy is mainly used for the diagnosis of primary syphilis. For optimal interpretation of the test result, dark-field microscopy requires the laboratory technician performing the microscopy to have a great deal of experience and expertise. In many settings in which patients with (ano)genital ulceration are seen, such as the office of a general practitioner (GP), dark-field microscopy is not available and a definite diagnosis of syphilis dep...

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confidence: 99%

Clinical Value of Treponema pallidum Real-Time PCR for Diagnosis of Syphilis

et al. 2010

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“…pallidum polA gene (TP0105) has been widely used as a target for detection of the syphilis agent according to the protocols of Liu et al (204) and Behrhorf et al (214). Several examples of quantitative amplification tests targeting polA are also available (215)(216)(217)). An alternative approach to DNA detection was proposed in 1997 by Centurion-Lara et al, who developed a reverse transcriptase PCR (RT-PCR) assay followed by probe hybridization to detect T. pallidum subsp.…”

Section: Direct Detection Methodsmentioning

confidence: 99%

The Endemic Treponematoses

2014

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SUMMARY The agents of human treponematoses include four closely related members of the genus Treponema : three subspecies of Treponema pallidum plus Treponema carateum . T. pallidum subsp. pallidum causes venereal syphilis, while T. pallidum subsp. pertenue , T. pallidum subsp. endemicum , and T. carateum are the agents of the endemic treponematoses yaws, bejel (or endemic syphilis), and pinta, respectively. All human treponematoses share remarkable similarities in pathogenesis and clinical manifestations, consistent with the high genetic and antigenic relatedness of their etiological agents. Distinctive features have been identified in terms of age of acquisition, most common mode of transmission, and capacity for invasion of the central nervous system and fetus, although the accuracy of these purported differences is debated among investigators and no biological basis for these differences has been identified to date. In 2012, the World Health Organization (WHO) officially set a goal for yaws eradication by 2020. This challenging but potentially feasible endeavor is favored by the adoption of oral azithromycin for mass treatment and the currently focused distribution of yaws and endemic treponematoses and has revived global interest in these fascinating diseases and their causative agents.

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“…Another study found positivity ratio of 39.1% for ttp47 PCR (260 bp) and 31.1% for polA PCR (378 bp), in blood samples from patients with latent syphilis (Castro et al, 2007). The real-time PCR had been developed for detection of T.pallidum DNA in clinical samples, they targeted polA gene (Heymans et al, 2010;Koek et al, 2006;Leslie et al, 2007) or tpp47 gene (Gayet-Ageron et al, 2009). The first test was validated using an analytical panel (n = 140) and a clinical panel of genital samples (n = 112) from patients attending a sexually transmitted infections clinic.…”

Section: Polymerase Chain Reaction (Pcr)mentioning

confidence: 99%

“…The first test was validated using an analytical panel (n = 140) and a clinical panel of genital samples (n = 112) from patients attending a sexually transmitted infections clinic. High sensitivities and specificities of 94-100% were achieved using two real-time PCR platforms, the Rotor-Gene and the iCycler (Koek et al, 2006). Leslie et al developed real-time PCR which analytical sensitivity was estimated to be 1.75 target copies per reaction.…”

Section: Polymerase Chain Reaction (Pcr)mentioning

confidence: 99%

Laboratorial Diagnosis of Syphilis

Sato¹

2011

Syphilis - Recognition, Description and Diagnosis

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Specific and sensitive diagnosis of syphilis using a real-time PCR for Treponema pallidum

Cited by 57 publications

References 11 publications

Clinical Value of Treponema pallidum Real-Time PCR for Diagnosis of Syphilis

Clinical Value of Treponema pallidum Real-Time PCR for Diagnosis of Syphilis

The Endemic Treponematoses

Laboratorial Diagnosis of Syphilis

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