Infectious diseases (London, England) · 2025
The utility of T. pallidum PCR testing in the diagnosis of congenital syphilis: a systematic review.
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Ryan C, Houlihan E, O'Reilly D, McCallion N, Drew R J
Аннотация
INTRODUCTION: Congenital syphilis (CS) due to maternal transmission of Treponema pallidum is rising. The interpretation of conventional diagnostic methods is complicated by maternal antibody transfer. Polymerase Chain Reaction (PCR) syphilis testing has been widely studied in adults. PCR is reliable, fast, and can be performed on a variety of sample types.
OBJECTIVES: This systematic review aimed to evaluate existing data and summarise current international recommendations on the use of PCR testing on placental and neonatal samples for the diagnosis of CS.
METHODS: A systematic search of PubMed, Ovid MEDLINE, and Cochrane databases was conducted, alongside an internet search of international congenital syphilis guidelines. The review was performed based on the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies: The PRISMA-DTA statement. The review was registered on the International Prospective Register of Systematic Reviews (PROSPERO). Studies reporting PCR testing on placental or neonatal samples in infants born to mothers with syphilis were included. Guidelines with specific recommendations for congenital syphilis PCR testing were included.
RESULTS: Of 221 studies screened, 21 were included, comprising 146 placental and 828 neonatal PCR samples. Only 4 multicentre studies were included. 8 studies included 5 or fewer PCR samples, including 5 single-patient case reports. Five international guidelines were included; all reserved PCR's application for high-risk infants with no clear guidance for low-risk infants.
DISCUSSION: PCR shows promise as an adjunct diagnostic tool for congenital syphilis. However, evidence remains limited. Multicentre diagnostic accuracy studies are urgently needed to inform international recommendations and optimise diagnostic strategies.
OBJECTIVES: This systematic review aimed to evaluate existing data and summarise current international recommendations on the use of PCR testing on placental and neonatal samples for the diagnosis of CS.
METHODS: A systematic search of PubMed, Ovid MEDLINE, and Cochrane databases was conducted, alongside an internet search of international congenital syphilis guidelines. The review was performed based on the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies: The PRISMA-DTA statement. The review was registered on the International Prospective Register of Systematic Reviews (PROSPERO). Studies reporting PCR testing on placental or neonatal samples in infants born to mothers with syphilis were included. Guidelines with specific recommendations for congenital syphilis PCR testing were included.
RESULTS: Of 221 studies screened, 21 were included, comprising 146 placental and 828 neonatal PCR samples. Only 4 multicentre studies were included. 8 studies included 5 or fewer PCR samples, including 5 single-patient case reports. Five international guidelines were included; all reserved PCR's application for high-risk infants with no clear guidance for low-risk infants.
DISCUSSION: PCR shows promise as an adjunct diagnostic tool for congenital syphilis. However, evidence remains limited. Multicentre diagnostic accuracy studies are urgently needed to inform international recommendations and optimise diagnostic strategies.