Clinical Value of Treponema pallidum Real-Time PCR for Diagnosis of Syphilis
Clinical Value of Treponema pallidum Real-Time PCR for Diagnosis of Syphilis
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DOI：
10.1128/jcm.00720-09
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发表时间：
2010-02-01
影响因子：
9.4
通讯作者：
Bruisten, S. M.
中科院分区：
文献类型：
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作者：
Heymans, R.;van der Helm, J. J.;Bruisten, S. M.
梅毒的诊断可能是复杂的，当它是基于不同的临床表现，暗视野显微镜检查和血清学。因此，在本研究中，我们研究了梅毒螺旋体实时TaqMan PCR检测一期和二期梅毒的额外临床价值。T.通过使用三种不同的算法来评估梅毒实时PCR诊断一期梅毒的价值：（i）暗视野显微镜结果与T.梅毒实时PCR结果，（ii）在性传播感染诊所（STI）（包括通过暗视野显微镜）和T.苍白球实时PCR结果，以及（iii）在全科医生办公室（无暗视野显微镜）和T.苍白球实时PCR结果。第四种算法用于确定T.梅毒实时荧光PCR检测二期梅毒。2006年12月至2008年4月，716例一期梅毒疑似病例和133例二期梅毒疑似病例纳入研究。暗视野显微镜与T.苍白球荧光定量PCR。T.苍白球实时PCR以及全科医生的诊断（kappa = 0.745）和STI诊所的诊断（kappa = 0.769）。对STI临床诊断的敏感性为72.8%，特异性为95.5%，阳性预测值为89.2%，阴性预测值为95.0%。霸王梅毒实时PCR是一种快速、有效、可靠的检测方法，可用于性病门诊和全科医生诊断一期梅毒，但对二期梅毒的诊断没有附加诊断价值。
The diagnosis of syphilis can be complicated when it is based on diverse clinical manifestations, dark-field microscopy, and serology. In the present study, therefore, we examined the additional clinical value of a Treponema pallidum real-time TaqMan PCR for the detection of primary and secondary syphilis. The additional value of the T. pallidum real-time PCR for the diagnosis of primary syphilis was evaluated by the use of three different algorithms: (i) a head-to-head comparison of the dark-field microscopy result and the T. pallidum real-time PCR result, (ii) comparison of the clinical diagnosis made in a sexually transmitted infection clinic (STI) (including by dark-field microscopy) and the T. pallidum real-time PCR result, and (iii) comparison of the clinical diagnosis made in a general practitioner's office (without dark-field microscopy) and the T. pallidum real-time PCR result. A fourth algorithm was used to determine the performance of the T. pallidum real-time PCR regarding the detection of secondary syphilis. From December 2006 to April 2008, 716 patients with suspected cases of primary syphilis and 133 patients with suspected cases of secondary syphilis were included in the study. A kappa value of 0.601 was found for the agreement between dark-field microscopy and the T. pallidum real-time PCR. Good agreement was found between the T. pallidum real-time PCR and both the diagnosis of the general practitioner (kappa = 0.745) and the diagnosis of the STI clinic (kappa = 0.769). The sensitivity with respect to the STI clinic diagnosis was 72.8%, the specificity was 95.5%, the positive predictive value was 89.2%, and the negative predictive value was 95.0%. The T. pallidum real-time PCR is a fast, efficient, and reliable test for the diagnosis of primary syphilis in an STI outpatient clinic and a general practitioner setting, but it has no added diagnostic value for the diagnosis of secondary syphilis.