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Comparative Analysis of Molecular and Serologic Testing for Primary Syphilis: A Population-Based Cohort Study
- Source :
- Frontiers in Cellular and Infection Microbiology, Frontiers in Cellular and Infection Microbiology, Vol 11 (2021)
- Publication Year :
- 2020
-
Abstract
- Rising rates of syphilis (T. pallidum; Tp) requires rapid diagnosis and treatment to manage the growing epidemic. Syphilis serology is imperfect and requires interpretation of multiple tests while molecular diagnostics allows for potential yes-no identification of highly infective, primary anogenital lesions. Accuracy of this testing modality has thus far been limited to small, highly selective studies. Therefore, we retrospectively assessed a large, adult population of patients with anogenital lesions seen at Sexually Transmitted Infection (STI) clinics in Alberta, Canada who were screened for syphilis and herpes simplex (HSV) 1/2 using PCR to evaluate Tp-PCR versus serology to diagnose primary syphilis. 114 (3.1%) of the 3,600 adult patients had at least one Tp-PCR+ anogenital lesion with 99 (2.8%) patients having newly positive syphilis serology (new INNO-LIA positive or 4-fold RPR increase). Tp-PCR had a sensitivity of 49.3% (95% CI 42.6-56.1) and specificity of 99.9% (99.7-100.0). Positive predictive values and negative predictive values in the study population or when corrected for provincial prevalence were 97.4% (92.5-99.5) or 0.4% (0.4-1.2) and 96.7% (96.1-97.3) or 100.0% (100.0-100.0), respectively. Positive and negative likelihood ratios were estimated at 555 (178-1733) and 0.5 (0.4-0.6), respectively. Review of all Tp-PCR performed with or without exclusion of HSV-positive lesions resulted in no significant change in Tp-PCR characteristics. Interestingly, 12 of the Tp-PCR+ samples had negative serology at time of lesion sampling but became positive within our 28-day testing window. Overall, this study further supports the use of Tp-PCR as an accurate assay to rapidly identify, treat, and prevent the spread of primary syphilis.
- Subjects :
- 0301 basic medicine
Microbiology (medical)
Adult
medicine.medical_specialty
serology diagnostic
030106 microbiology
Immunology
Primary Syphilis
syphilis
Microbiology
Sensitivity and Specificity
Serology
Lesion
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Cellular and Infection Microbiology
Internal medicine
medicine
Humans
Sampling (medicine)
Serologic Tests
030212 general & internal medicine
sexually transmitted diseases (STDs)
anogenital lesions
sexually transmitted infections
Retrospective Studies
Sexually transmitted diseases (STDs)
business.industry
molecular diagnostic
Brief Research Report
Molecular diagnostics
medicine.disease
QR1-502
Infectious Diseases
Population study
Syphilis
medicine.symptom
business
treponema pallidum
Subjects
Details
- ISSN :
- 22352988
- Volume :
- 11
- Database :
- OpenAIRE
- Journal :
- Frontiers in cellular and infection microbiology
- Accession number :
- edsair.doi.dedup.....88867e4d5b65bf3117c625851cbca837