International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2025
Reevaluating serological patterns in syphilis: new insights into the dynamic trend of treponemal and nontreponemal antibodies across disease stages based on a meta-analysis.
СтатьяМетаанализСистематический обзорНазвание и аннотация: Перевод в очереди
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Xie Jia-Wen, Fan Shu-Hao, Guo Yin-Feng, Zheng Ying, Zhang Wei, Wang Cheng, Lin Yi-Qiang, Yang Tian-Ci, Lin Li-Rong
Аннотация
OBJECTIVES: Conventional models assume lifelong Treponemal antibody test (TT) positivity and progressive nontreponemal antibody test (NTT) decline in syphilis, yet emerging evidence challenges these assumptions. This study aimed to quantify stage-specific antibody dynamics and address discrepancies in historical serological trend charts.
METHODS: This meta-analysis adhered to the PRISMA guidelines for systematic reviews and meta-analyses, and the study protocol was registered in the PROSPERO database (CRD420251145655). We systematically searched the PubMed, Web of Science, Embase, and CNKI databases and conducted a pooled analysis of 167 studies. The pooled positivity rates were calculated via random-effects models. Heterogeneity, publication bias, and the positive rates of serological tests at each disease stage were systematically evaluated.
RESULTS: TT positivity remained high across all stages, with 89.26% in primary syphilis, peaking at 97.43% in secondary syphilis, and gradually declining in latent (94.18%) and tertiary syphilis (93.83%). Nontreponemal antibodies showed greater fluctuations, rising from 77.85% in primary syphilis to 96.69% in secondary syphilis, then decreasing to 81.92% in latent syphilis and 71.58% in tertiary syphilis. Significant heterogeneity and publication bias were observed, yet sensitivity analyses confirmed result stability.
CONCLUSIONS: This study provides the first evidence-based chart of treponemal and nontreponemal antibody dynamics across syphilis stages. Our findings challenge the reliability of treponemal antibodies as lifelong markers and highlight the limitations of nontreponemal titers in confirming serological cure. These results emphasize the need for updated diagnostic guidelines and personalized monitoring and serve as evidence-based evidence to support guideline revisions.
METHODS: This meta-analysis adhered to the PRISMA guidelines for systematic reviews and meta-analyses, and the study protocol was registered in the PROSPERO database (CRD420251145655). We systematically searched the PubMed, Web of Science, Embase, and CNKI databases and conducted a pooled analysis of 167 studies. The pooled positivity rates were calculated via random-effects models. Heterogeneity, publication bias, and the positive rates of serological tests at each disease stage were systematically evaluated.
RESULTS: TT positivity remained high across all stages, with 89.26% in primary syphilis, peaking at 97.43% in secondary syphilis, and gradually declining in latent (94.18%) and tertiary syphilis (93.83%). Nontreponemal antibodies showed greater fluctuations, rising from 77.85% in primary syphilis to 96.69% in secondary syphilis, then decreasing to 81.92% in latent syphilis and 71.58% in tertiary syphilis. Significant heterogeneity and publication bias were observed, yet sensitivity analyses confirmed result stability.
CONCLUSIONS: This study provides the first evidence-based chart of treponemal and nontreponemal antibody dynamics across syphilis stages. Our findings challenge the reliability of treponemal antibodies as lifelong markers and highlight the limitations of nontreponemal titers in confirming serological cure. These results emphasize the need for updated diagnostic guidelines and personalized monitoring and serve as evidence-based evidence to support guideline revisions.