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PCR-detection rates of T. pallidum ssp. pallidum in swab samples from the Czech Republic (2004-2022): Combined RPR, IgM, and PCR tests efficiently detect active syphilis

E. Vrbová, P. Pospíšilová, E. Dastychová, M. Kojanová, M. Kreidlová, D. Vaňousová, F. Rob, P. Procházka, A. Krchňáková, V. Vašků, R. Strnadel, O. Faustmannová, MD. Heroldová, I. Kuklová, H. Zákoucká, D. Šmajs

. 2025 ; 318 (-) : 151647. [pub] 20250205

Language English Country Germany

Document type Journal Article

Persistent link   https://www.medvik.cz/link/bmc25009644

Syphilis is a multistage sexually transmitted disease caused by Treponema pallidum ssp. pallidum (TPA). This study analyzed clinical samples collected from patients with a diagnosed syphilis infection from 2004-2022, isolated in the Czech Republic. Mucocutaneous swab samples (n = 543) from 543 patients were analyzed, and from these samples, 80.11 % (n = 435) were PCR positive, and 19.89 % (n = 108) were PCR negative for TPA DNA. Swabs were more often positive when collected from syphilis patients in the primary and secondary stages, compared to the latent or unknown stage. There was no significant difference in PCR positivity between the primary and secondary stages (p = 0.099). In IgM-positive patients, a statistically significant association with PCR-positivity was found in samples from seropositive (p = 0.033) and serodiscrepant (RPR negative) patients (p = 0.0006). When assessing our laboratory-defined cases of syphilis, the RPR, IgM, and PCR tests were similarly effective (within the range of 80.1-86.1 %). However, parallel testing with these methods was even more effective, i.e., RPR + PCR was 96.1 % effective and RPR + IgM + PCR was 97.8 % effective. A combination of RPR + PCR, or a combination of all three tests (RPR, IgM, and PCR) can therefore be used to reliably detect active syphilis cases, including reinfections. Our findings show that the reverse algorithm for detecting syphilis could be substantially improved by adding IgM and PCR testing.

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$a Syphilis is a multistage sexually transmitted disease caused by Treponema pallidum ssp. pallidum (TPA). This study analyzed clinical samples collected from patients with a diagnosed syphilis infection from 2004-2022, isolated in the Czech Republic. Mucocutaneous swab samples (n = 543) from 543 patients were analyzed, and from these samples, 80.11 % (n = 435) were PCR positive, and 19.89 % (n = 108) were PCR negative for TPA DNA. Swabs were more often positive when collected from syphilis patients in the primary and secondary stages, compared to the latent or unknown stage. There was no significant difference in PCR positivity between the primary and secondary stages (p = 0.099). In IgM-positive patients, a statistically significant association with PCR-positivity was found in samples from seropositive (p = 0.033) and serodiscrepant (RPR negative) patients (p = 0.0006). When assessing our laboratory-defined cases of syphilis, the RPR, IgM, and PCR tests were similarly effective (within the range of 80.1-86.1 %). However, parallel testing with these methods was even more effective, i.e., RPR + PCR was 96.1 % effective and RPR + IgM + PCR was 97.8 % effective. A combination of RPR + PCR, or a combination of all three tests (RPR, IgM, and PCR) can therefore be used to reliably detect active syphilis cases, including reinfections. Our findings show that the reverse algorithm for detecting syphilis could be substantially improved by adding IgM and PCR testing.
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$a Dastychová, Eliška $u Department of Dermatovenerology, St. Anne ́s Hospital and Masaryk University, Brno, Czech Republic
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$a Kojanová, Martina $u Department of Dermatology and Venereology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
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$a Kreidlová, Miluše $u Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine of Charles University and General University Hospital, Prague, Czech Republic
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$a Vaňousová, Daniela $u Department of Dermatovenerology, Second Faculty of Medicine, Charles University, Bulovka University Hospital, Prague, Czech Republic
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$a Rob, Filip $u Department of Dermatovenerology, Second Faculty of Medicine, Charles University, Bulovka University Hospital, Prague, Czech Republic
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$a Procházka, Přemysl $u Outpatient STI Clinic Medicentrum, Prague, Czech Republic
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$a Krchňáková, Alena $u Department of Dermatovenerology, St. Anne ́s Hospital and Masaryk University, Brno, Czech Republic
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$a Strnadel, Radim $u Department of Dermatovenerology, Faculty Hospital Brno, Brno, Czech Republic
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$a Faustmannová, Olga $u Department of Dermatovenerology, Faculty Hospital Brno, Brno, Czech Republic
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$a Šmajs, David $u Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic. Electronic address: dsmajs@med.muni.cz
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