Detection of Treponema pallidum DNA in Oropharyngeal Swabs and Whole Blood for Syphilis Diagnosis.
Journal
Sexually transmitted diseases
ISSN: 1537-4521
Titre abrégé: Sex Transm Dis
Pays: United States
ID NLM: 7705941
Informations de publication
Date de publication:
01 12 2021
01 12 2021
Historique:
pubmed:
25
5
2021
medline:
15
12
2021
entrez:
24
5
2021
Statut:
ppublish
Résumé
Syphilis diagnosis relies on serological tests, which may be falsely nonreactive or may be reactive but not reflect current syphilis. Polymerase chain reaction for detection of T. pallidum DNA was performed on 123 oropharyngeal swabs, 120 whole bloods, and 46 lesion exudate swabs from 123 untreated individuals with syphilis (cases); oropharyngeal swabs from 148 at-risk controls without syphilis; and 73 oropharyngeal swabs and 36 whole bloods from 73 individuals recently treated for syphilis. Most (90.2%) cases had early syphilis. T. pallidum DNA was detected in 33 (26.8%) of 123 oropharyngeal swabs, 32 (26.7%) of 120 bloods, and 30 (65.2%) of 46 lesion exudate swabs. T. pallidum DNA was detected in 49 (40.8%) of 120 individuals in whom both oropharyngeal swabs and blood were tested. T. pallidum was more likely to be amplified from oropharyngeal swabs when it was amplified from blood than when it was not (15 of 32 [46.9%] vs. 17 of 88 [19.3%], P = 0.003). For each 2-fold increase in serum rapid plasma reagin titer, the odds of detection of T. pallidum DNA in oropharyngeal swabs increased by 1.44 (95% confidence interval, 1.14-1.82, P = 0.003). T. pallidum DNA was not detected in oropharyngeal samples from controls, but it was detected in 3 (8.3%) of 36 bloods from individuals recently treated for syphilis: 2 at 1 day and 1 at 5 days after initiation of syphilis treatment. Nucleic amplification tests can identify recent T. pallidum infection and may be particularly useful for diagnosis of very early or asymptomatic syphilis.
Sections du résumé
BACKGROUND
Syphilis diagnosis relies on serological tests, which may be falsely nonreactive or may be reactive but not reflect current syphilis.
METHODS
Polymerase chain reaction for detection of T. pallidum DNA was performed on 123 oropharyngeal swabs, 120 whole bloods, and 46 lesion exudate swabs from 123 untreated individuals with syphilis (cases); oropharyngeal swabs from 148 at-risk controls without syphilis; and 73 oropharyngeal swabs and 36 whole bloods from 73 individuals recently treated for syphilis.
RESULTS
Most (90.2%) cases had early syphilis. T. pallidum DNA was detected in 33 (26.8%) of 123 oropharyngeal swabs, 32 (26.7%) of 120 bloods, and 30 (65.2%) of 46 lesion exudate swabs. T. pallidum DNA was detected in 49 (40.8%) of 120 individuals in whom both oropharyngeal swabs and blood were tested. T. pallidum was more likely to be amplified from oropharyngeal swabs when it was amplified from blood than when it was not (15 of 32 [46.9%] vs. 17 of 88 [19.3%], P = 0.003). For each 2-fold increase in serum rapid plasma reagin titer, the odds of detection of T. pallidum DNA in oropharyngeal swabs increased by 1.44 (95% confidence interval, 1.14-1.82, P = 0.003). T. pallidum DNA was not detected in oropharyngeal samples from controls, but it was detected in 3 (8.3%) of 36 bloods from individuals recently treated for syphilis: 2 at 1 day and 1 at 5 days after initiation of syphilis treatment.
CONCLUSIONS
Nucleic amplification tests can identify recent T. pallidum infection and may be particularly useful for diagnosis of very early or asymptomatic syphilis.
Identifiants
pubmed: 34030158
doi: 10.1097/OLQ.0000000000001476
pii: 00007435-202112000-00003
pmc: PMC8595773
mid: NIHMS1744453
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
915-918Subventions
Organisme : NINDS NIH HHS
ID : R01 NS034235
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS082120
Pays : United States
Informations de copyright
Copyright © 2021 American Sexually Transmitted Diseases Association. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of Interest and Sources of Funding: The authors have no conflict of interest relevant to this work. This work was supported by grants from the National Institutes of Health (NS34235 and NS082120) to C.M.M.
Références
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2018. Atlanta, GA: U.S. Department of Health and Human Services, 2019.
European Centre for Disease Prevention and Control. Syphilis. In: Annual Epidemiological Report for 2018. Stockholm: ECDC, 2020.
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64(RR-03):1–137.
Golden M, O'Donnell M, Lukehart S, et al. Treponema pallidum nucleic acid amplification testing to augment syphilis screening among men who have sex with men. J Clin Microbiol 2019; 57:e00572–19.
Yang CJ, Chang SY, Wu BR, et al. Unexpectedly high prevalence of Treponema pallidum infection in the oral cavity of human immunodeficiency virus–infected patients with early syphilis who had engaged in unprotected sex practices. Clin Microbiol Infect 2015; 21:787.e1–787.e7.
Wang C, Hu Z, Zheng X, et al. A new specimen for syphilis diagnosis: Evidence by high loads of Treponema pallidum DNA in saliva. Clin Infect Dis 2020; ciaa1613.
Marra CM, Sahi SK, Tantalo LC, et al. Enhanced molecular typing of treponema pallidum: Geographical distribution of strain types and association with neurosyphilis. J Infect Dis 2010; 202:1380–1388.
Marra CM, Tantalo LC, Sahi SK, et al. Reduced Treponema pallidum –specific opsonic antibody activity in HIV-infected patients with syphilis. J Infect Dis 2016; 213:1348–1354.
Larsen SA, Pope V, Johnson RE, et al. A Manual of Tests for Syphilis. 9th ed. Washington, DC: American Public Health Association, 1998.