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. 2003 Dec;79(6):479–483. doi: 10.1136/sti.79.6.479

Use of PCR in the diagnosis of early syphilis in the United Kingdom

H Palmer 1, S Higgins 1, A Herring 1, M Kingston 1
PMCID: PMC1744778  PMID: 14663125

Abstract

Objectives: To evaluate a Treponema pallidum polymerase chain reaction (PCR) test in the laboratory diagnosis of early syphilis in the United Kingdom.

Subjects and setting: Men and women attending genitourinary medicine clinics in England.

Methods: A trial PCR service was offered for the analysis of swabs of ano-genital or oral ulcers suspected to be syphilitic in origin. Clinical details, results of treponemal serology, and other relevant laboratory tests carried out by the sending laboratories were obtained retrospectively by questionnaire.

Results: Data from 98 patients, representing 100 episodes of ulceration, were analysed. The majority of patients (70) attended clinics in the Greater Manchester area. Eighty six patients were male and 58 were men who have sex with men (MSM), of whom 24 were HIV positive. PCR results agreed with the clinical diagnosis for 95 patients; samples from 26 patients were PCR positive and serologically diagnosed as primary (18) or secondary (8) syphilis, whereas 70 patients had PCR negative samples and were not diagnosed as having active syphilis. These data include two HIV positive patients who were PCR positive 12 and 21 days before their treponemal seroconversion. One positive PCR result was not supported by positive treponemal serology (this patient coincidentally received a 10 day course of co-amoxiclav 1 week after sampling). Three patients had negative PCR results but positive syphilis serology. The sensitivity, specificity, positive and negative predictive value for primary syphilis were 94.7%, 98.6%, 94.7%, and 98.6%, respectively, and for secondary syphilis these were 80.0%, 98.6%, 88.9%, and 97.2%, respectively.

Conclusion: PCR is a sensitive and specific test for T pallidum, and an important adjunct to dark ground microscopy and treponemal serology in diagnosing infectious syphilis in the United Kingdom.

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Selected References

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  1. Battu V. R., Horner P. J., Taylor P. K., Jephcott A. E., Egglestone S. I. Locally acquired heterosexual outbreak of syphilis in Bristol. Lancet. 1997 Oct 11;350(9084):1100–1101. doi: 10.1016/S0140-6736(05)70460-8. [DOI] [PubMed] [Google Scholar]
  2. Behets F. M., Andriamiadana J., Randrianasolo D., Randriamanga R., Rasamilalao D., Chen C. Y., Weiss J. B., Morse S. A., Dallabetta G., Cohen M. S. Chancroid, primary syphilis, genital herpes, and lymphogranuloma venereum in Antananarivo, Madagascar. J Infect Dis. 1999 Oct;180(4):1382–1385. doi: 10.1086/315005. [DOI] [PubMed] [Google Scholar]
  3. Behets F. M., Brathwaite A. R., Hylton-Kong T., Chen C. Y., Hoffman I., Weiss J. B., Morse S. A., Dallabetta G., Cohen M. S., Figueroa J. P. Genital ulcers: etiology, clinical diagnosis, and associated human immunodeficiency virus infection in Kingston, Jamaica. Clin Infect Dis. 1999 May;28(5):1086–1090. doi: 10.1086/514751. [DOI] [PubMed] [Google Scholar]
  4. Beyrer C., Jitwatcharanan K., Natpratan C., Kaewvichit R., Nelson K. E., Chen C. Y., Weiss J. B., Morse S. A. Molecular methods for the diagnosis of genital ulcer disease in a sexually transmitted disease clinic population in northern Thailand: predominance of herpes simplex virus infection. J Infect Dis. 1998 Jul;178(1):243–246. doi: 10.1086/515603. [DOI] [PubMed] [Google Scholar]
  5. Burstain J. M., Grimprel E., Lukehart S. A., Norgard M. V., Radolf J. D. Sensitive detection of Treponema pallidum by using the polymerase chain reaction. J Clin Microbiol. 1991 Jan;29(1):62–69. doi: 10.1128/jcm.29.1.62-69.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Centurion-Lara A., Castro C., Castillo R., Shaffer J. M., Van Voorhis W. C., Lukehart S. A. The flanking region sequences of the 15-kDa lipoprotein gene differentiate pathogenic treponemes. J Infect Dis. 1998 Apr;177(4):1036–1040. doi: 10.1086/515247. [DOI] [PubMed] [Google Scholar]
  7. Centurion-Lara A., Castro C., Shaffer J. M., Van Voorhis W. C., Marra C. M., Lukehart S. A. Detection of Treponema pallidum by a sensitive reverse transcriptase PCR. J Clin Microbiol. 1997 Jun;35(6):1348–1352. doi: 10.1128/jcm.35.6.1348-1352.1997. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cummings M. C., Lukehart S. A., Marra C., Smith B. L., Shaffer J., Demeo L. R., Castro C., McCormack W. M. Comparison of methods for the detection of treponema pallidum in lesions of early syphilis. Sex Transm Dis. 1996 Sep-Oct;23(5):366–369. doi: 10.1097/00007435-199609000-00004. [DOI] [PubMed] [Google Scholar]
  9. Egglestone S. I., Turner A. J. Serological diagnosis of syphilis. PHLS Syphilis Serology Working Group. Commun Dis Public Health. 2000 Sep;3(3):158–162. [PubMed] [Google Scholar]
  10. Fenton K. A., Nicoll A., Kinghorn G. Resurgence of syphilis in England: time for more radical and nationally coordinated approaches. Sex Transm Infect. 2001 Oct;77(5):309–310. doi: 10.1136/sti.77.5.309. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Fleming D. T., Wasserheit J. N. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect. 1999 Feb;75(1):3–17. doi: 10.1136/sti.75.1.3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hay P. E., Clarke J. R., Strugnell R. A., Taylor-Robinson D., Goldmeier D. Use of the polymerase chain reaction to detect DNA sequences specific to pathogenic treponemes in cerebrospinal fluid. FEMS Microbiol Lett. 1990 Mar 15;56(3):233–238. doi: 10.1111/j.1574-6968.1990.tb13943.x. [DOI] [PubMed] [Google Scholar]
  13. Hook E. W., 3rd, Roddy R. E., Lukehart S. A., Hom J., Holmes K. K., Tam M. R. Detection of Treponema pallidum in lesion exudate with a pathogen-specific monoclonal antibody. J Clin Microbiol. 1985 Aug;22(2):241–244. doi: 10.1128/jcm.22.2.241-244.1985. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Hopkins S., Lyons F., Mulcahy F., Bergin C. The great pretender returns to Dublin, Ireland. Sex Transm Infect. 2001 Oct;77(5):316–318. doi: 10.1136/sti.77.5.316. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Liu H., Rodes B., Chen C. Y., Steiner B. New tests for syphilis: rational design of a PCR method for detection of Treponema pallidum in clinical specimens using unique regions of the DNA polymerase I gene. J Clin Microbiol. 2001 May;39(5):1941–1946. doi: 10.1128/JCM.39.5.1941-1946.2001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Mertz K. J., Trees D., Levine W. C., Lewis J. S., Litchfield B., Pettus K. S., Morse S. A., St Louis M. E., Weiss J. B., Schwebke J. Etiology of genital ulcers and prevalence of human immunodeficiency virus coinfection in 10 US cities. The Genital Ulcer Disease Surveillance Group. J Infect Dis. 1998 Dec;178(6):1795–1798. doi: 10.1086/314502. [DOI] [PubMed] [Google Scholar]
  17. Mertz K. J., Weiss J. B., Webb R. M., Levine W. C., Lewis J. S., Orle K. A., Totten P. A., Overbaugh J., Morse S. A., Currier M. M. An investigation of genital ulcers in Jackson, Mississippi, with use of a multiplex polymerase chain reaction assay: high prevalence of chancroid and human immunodeficiency virus infection. J Infect Dis. 1998 Oct;178(4):1060–1066. doi: 10.1086/515664. [DOI] [PubMed] [Google Scholar]
  18. Morse S. A., Trees D. L., Htun Y., Radebe F., Orle K. A., Dangor Y., Beck-Sague C. M., Schmid S., Fehler G., Weiss J. B. Comparison of clinical diagnosis and standard laboratory and molecular methods for the diagnosis of genital ulcer disease in Lesotho: association with human immunodeficiency virus infection. J Infect Dis. 1997 Mar;175(3):583–589. doi: 10.1093/infdis/175.3.583. [DOI] [PubMed] [Google Scholar]
  19. Noordhoek G. T., Wolters E. C., de Jonge M. E., van Embden J. D. Detection by polymerase chain reaction of Treponema pallidum DNA in cerebrospinal fluid from neurosyphilis patients before and after antibiotic treatment. J Clin Microbiol. 1991 Sep;29(9):1976–1984. doi: 10.1128/jcm.29.9.1976-1984.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Orle K. A., Gates C. A., Martin D. H., Body B. A., Weiss J. B. Simultaneous PCR detection of Haemophilus ducreyi, Treponema pallidum, and herpes simplex virus types 1 and 2 from genital ulcers. J Clin Microbiol. 1996 Jan;34(1):49–54. doi: 10.1128/jcm.34.1.49-54.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Pillay A., Liu H., Chen C. Y., Holloway B., Sturm A. W., Steiner B., Morse S. A. Molecular subtyping of Treponema pallidum subspecies pallidum. Sex Transm Dis. 1998 Sep;25(8):408–414. doi: 10.1097/00007435-199809000-00004. [DOI] [PubMed] [Google Scholar]
  22. Poulton M., Dean G. L., Williams D. I., Carter P., Iversen A., Fisher M. Surfing with spirochaetes: an ongoing syphilis outbreak in Brighton. Sex Transm Infect. 2001 Oct;77(5):319–321. doi: 10.1136/sti.77.5.319. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Risbud A., Chan-Tack K., Gadkari D., Gangakhedkar R. R., Shepherd M. E., Bollinger R., Mehendale S., Gaydos C., Divekar A., Rompalo A. The etiology of genital ulcer disease by multiplex polymerase chain reaction and relationship to HIV infection among patients attending sexually transmitted disease clinics in Pune, India. Sex Transm Dis. 1999 Jan;26(1):55–62. doi: 10.1097/00007435-199901000-00009. [DOI] [PubMed] [Google Scholar]
  24. Romanowski B., Forsey E., Prasad E., Lukehart S., Tam M., Hook E. W., 3rd Detection of Treponema pallidum by a fluorescent monoclonal antibody test. Sex Transm Dis. 1987 Jul-Sep;14(3):156–159. doi: 10.1097/00007435-198707000-00007. [DOI] [PubMed] [Google Scholar]
  25. Rompalo A. M., Lawlor J., Seaman P., Quinn T. C., Zenilman J. M., Hook E. W., 3rd Modification of syphilitic genital ulcer manifestations by coexistent HIV infection. Sex Transm Dis. 2001 Aug;28(8):448–454. doi: 10.1097/00007435-200108000-00004. [DOI] [PubMed] [Google Scholar]
  26. Schmidt B. L., Edjlalipour M., Luger A. Comparative evaluation of nine different enzyme-linked immunosorbent assays for determination of antibodies against Treponema pallidum in patients with primary syphilis. J Clin Microbiol. 2000 Mar;38(3):1279–1282. doi: 10.1128/jcm.38.3.1279-1282.2000. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Wicher K., Horowitz H. W., Wicher V. Laboratory methods of diagnosis of syphilis for the beginning of the third millennium. Microbes Infect. 1999 Oct;1(12):1035–1049. doi: 10.1016/s1286-4579(99)80521-8. [DOI] [PubMed] [Google Scholar]

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