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Review
. 2023 Jul-Dec;21(12):1339-1354.
doi: 10.1080/14787210.2023.2280214. Epub 2023 Nov 24.

Advantages and limitations of current diagnostic laboratory approaches in syphilis and congenital syphilis

Weiping Cao  1 , Phoebe G Thorpe  1 , Kevin O'Callaghan  1 , Ellen N Kersh  1
Affiliations
Review

Advantages and limitations of current diagnostic laboratory approaches in syphilis and congenital syphilis

Weiping Cao et al. Expert Rev Anti Infect Ther. 2023 Jul-Dec.

Abstract

Introduction: The reemergence of syphilis, especially congenital syphilis, presents a significant public health threat. Accurate diagnosis of syphilis depends on recognition of a constellation of symptoms, review of medical and sexual history, and multiple laboratory tests. While reliable, current tests for syphilis can be difficult to interpret, which can lead to delays in treatment.

Area covered: This review summarizes the major advantages and limitations of available diagnostic laboratory methods for syphilis, provides an update on recent advances in laboratory tools, and highlights the urgent need for coordinated efforts to create new tools to halt the resurgence of syphilis.

Expert opinion: In syphilis, the wide variety of short-lived signs and symptoms followed by periods of latency create diagnostic challenges. Currently available laboratory tests, when positive, require additional information to interpret (prior testing, treatment, and sexual history). Point-of-care tests that can rapidly and accurately detect both treponemal and non-treponemal antibodies would be a huge step toward reducing test turnaround time and time to treatment. Incorporating biological insights and technology innovations to advance the development of direct detection assays is urgently needed. A comprehensive coordinated effort is critical to stem the tide of rising syphilis in the United States and globally.

Keywords: Congenital syphilis; molecular detection; nontreponemal test; serologic test; syphilis; syphilis screening; treponema pallidum; treponemal test.

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Figures

Figure 1.
Figure 1.
Serological responses and clinical manifestations & management of syphilis infection.
Figure 2.
Figure 2.
Syphilis serology testing algorithm.
Figure 3.
Figure 3.
Recommendations for evaluation and treatment of suspected congenital syphilis.
See this image and copyright information in PMC

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