A retrospective study on nested PCR detection of syphilis treponemes in clinical samples: PCR detection contributes to the diagnosis of syphilis in patients with seronegative and serodiscrepant results

Syphilis, caused by Treponema pallidum ssp. pallidum (TPA), is a persisting global health problem. Although syphilis diagnostics relies mainly on serology, serological tests have some limitations, and it is recommended that the final diagnosis be supported by additional tests. The purpose of this st...

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Published in:	PloS one Vol. 15; no. 8; p. e0237949
Main Authors:	Vrbove, Eliska, Mikalova, Lenka, Grillova, Linda, Pospisilova, Petra, Strnadel, Radim, Dastychova, Eliska, Kojanova, Martina, Kreidlova, Miluse, Vanousova, Daniela, Rob, Filip, Prochazka, Premysl, Krchnakova, Alena, Vasku, Vladimír, Woznicova, Vladana, Dvorakova Heroldova, Monika, Kuklova, Ivana, Zakoucka, Hana, Smajs, David
Format:	Journal Article
Language:	English
Published:	San Francisco Public Library of Science 20-08-2020 Public Library of Science (PLoS)
Subjects:	Biology Biology and Life Sciences Deoxyribonucleic acid Dermatology Diagnosis DNA EDTA Global health Globus pallidus Hospitals Identification and classification Laboratories Medical diagnosis Medicine Medicine and Health Sciences Methods Molecular diagnostic techniques Polymerase chain reaction Public health Research and Analysis Methods Serological tests Serology Sexually transmitted diseases STD Syphilis Treponema Ulcers Czech Republic Ireland
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Summary:	Syphilis, caused by Treponema pallidum ssp. pallidum (TPA), is a persisting global health problem. Although syphilis diagnostics relies mainly on serology, serological tests have some limitations, and it is recommended that the final diagnosis be supported by additional tests. The purpose of this study was to analyze the relationship between serology and PCR in syphilis diagnostics. From the year 2004 to May 2019, a total of 941 samples were taken from 833 patients suspected of having syphilis, in Czech Republic. In all these samples, both nested PCR detection of TPA and serology testing were performed. Of the 941 samples, 126 were seronegative, 651 were seropositive, and 164 were serodiscrepant. Among seronegative samples (n = 126), 11 were PCR-positive (8.7%). Among seropositive samples (n = 651; i.e., samples positive for both non-treponemal and treponemal serology tests), 368 samples were PCR-positive (56.5%). The remaining 164 serodiscrepant samples included RPR negative and treponemal serological test-positive samples (n = 154) and a set of 10 RPR-positive samples negative in treponemal serological tests. While the first group revealed 73 PCR-positive samples (47.4%), the second revealed 5 PCR positive samples (50.0%). PCR detection rates were highest in primary syphilis, with lower rates in the secondary and undetermined syphilis stages. As shown here, the nested PCR can improve diagnostics of syphilis, especially in seronegative patients and in patients with discrepant serology.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0237949