title: A longitudinal evaluation of Treponema pallidum PCR testing in early syphilis.
abstract: BACKGROUND
  Syphilis is a growing public health problem among men who have sex with men (MSM) globally. Rapid and accurate detection of syphilis is vital to ensure patients and their contacts receive timely treatment and reduce ongoing transmission.
  
  
  METHODS
  We evaluated a PCR assay for the diagnosis of Treponema pallidum using swabs of suspected early syphilis lesions in longitudinally assessed MSM.
  
  
  RESULTS
  We tested 260 MSM for T pallidum by PCR on 288 occasions: 77 (26.7%) had early syphilis that was serologically confirmed at baseline or within six weeks, and 211 (73.3%) remained seronegative for syphilis. Of 55 men with primary syphilis, 49 were PCR positive, giving a sensitivity of 89.1% (95% CI: 77.8%-95.9%) and a specificity of 99.1% (95% CI: 96.5%-99.9%). Of 22 men with secondary syphilis, 11 were PCR positive, giving a sensitivity of 50% (95% CI: 28.2%-71.8%) and a specificity of 100% (95% CI: 66.4%-71.8%). Of the 77 syphilis cases, 43 (56%) were HIV positive and the sensitivity and specificity of the PCR test did not vary by HIV status. The PCR test was able to detect up to five (10%) primary infections that were initially seronegative, including one HIV positive man with delayed seroconversion to syphilis (72 to 140 days) and one HIV positive man who did not seroconvert to syphilis over 14 months follow-up. Both men had been treated for syphilis within a week of the PCR test.
  
  
  CONCLUSIONS
  T pallidum PCR is a potentially powerful tool for the early diagnosis of primary syphilis, particularly where a serological response has yet to develop.
authors.affiliation: mattshields@tspc.com.au
authors.forename: Matt
authors.initials: M
authors.lastname: Shields
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Guy
authors.forename: Neisha J
authors.initials: NJ
authors.lastname: Jeoffreys
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Finlayson
authors.forename: Basil
authors.initials: B
authors.lastname: Donovan
mesh_terms: D001431:Bacteriological Techniques / Q000379:methods*; D042241:Early Diagnosis; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D016133:Polymerase Chain Reaction / Q000379:methods*; D012680:Sensitivity and Specificity; D013587:Syphilis / Q000175:diagnosis*; D014210:Treponema pallidum / Q000235:genetics / Q000302:isolation & purification*