采用梅毒螺旋体转录介导扩增检测法及时诊断潜伏期梅毒感染。

Timely Diagnosis of Incubating Syphilis Infections Using Treponema pallidum Transcription-Mediated Amplification Assay.

机构信息

Department of Infectious Diseases, Public Health Laboratory, Public Health Service of Amsterdam, Amsterdam, The Netherlands.

Department of Medical Microbiology, University of Amsterdam, Amsterdam Institute for Infection & Immunity, Amsterdam Medical Center, Amsterdam, The Netherlands.

出版信息

Clin Infect Dis. 2023 Dec 15;77(12):1717-1722. doi: 10.1093/cid/ciad455.

DOI:10.1093/cid/ciad455

PMID:37536265

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10724458/

Abstract

BACKGROUND

Syphilis is a complex, multistage, sexually transmitted infection (STI) caused by the bacterium Treponema pallidum subspecies pallidum (TP). New diagnostic tools are needed to minimize transmission. In this study, we aimed to assess the additional value of an investigational transcription-mediated amplification test for TP (TP-TMA) for routine diagnostics.

METHODS

Between September 2021 and August 2022, visits by all participants of the national preexposure prophylaxis (PrEP) program at the sexual health center (SHC) in Amsterdam were included. Anal, pharyngeal, vaginal, and urine samples collected for Chlamydia trachomatis and Neisseria gonorrhoeae screening were additionally tested with the TP-TMA assay based on detection of 23S rRNA of TP.

RESULTS

In total, 9974 SHC visits by 3283 participants were included. There were 191 infectious syphilis cases diagnosed: 26 (14%) primary syphilis, 54 (29%) secondary syphilis, and 111 (58%) early latent syphilis. In 79 of the 191 (41%) syphilis cases, at least 1 sample was TP-TMA-positive. For 16 participants, the positive TP-TMA result was not concordant with routine diagnostics. Of those, 2 participants were treated for syphilis within a week before the visit. Eight participants were treated for a syphilis notification at the visit or for another STI. Five participants were diagnosed with syphilis at the following visit, and 1 participant was lost to follow-up.

CONCLUSIONS

By adding the TP-TMA assay to routine diagnostics, we identified 14 of 191 (7%) additional syphilis infections among participants of the national PrEP program. The TP-TMA assay is a useful diagnostic tool to increase syphilis case finding and thus limit the transmission of syphilis.

摘要

背景

梅毒是一种由苍白密螺旋体亚种苍白密螺旋体（TP）引起的复杂、多阶段的性传播感染（STI）。需要新的诊断工具来最大限度地减少传播。在这项研究中，我们旨在评估一种用于常规诊断的实验性转录介导扩增检测 TP（TP-TMA）的额外价值。

方法

2021 年 9 月至 2022 年 8 月期间，阿姆斯特丹性健康中心（SHC）国家暴露前预防（PrEP）计划的所有参与者的就诊均被纳入研究。为了筛查沙眼衣原体和淋病奈瑟菌，对采集的肛门、咽、阴道和尿液样本进行了 TP-TMA 检测，该检测基于 TP 的 23S rRNA 检测。

结果

共纳入了 3283 名参与者的 9974 次 SHC 就诊。诊断出 191 例传染性梅毒病例：26 例（14%）原发性梅毒、54 例（29%）二期梅毒和 111 例（58%）早期潜伏梅毒。在 191 例梅毒病例中，有 79 例（41%）至少有 1 份样本 TP-TMA 阳性。对于 16 名参与者，TP-TMA 的阳性结果与常规诊断不一致。其中，2 名参与者在就诊前一周内接受了梅毒治疗。8 名参与者在就诊时或因另一种性传播感染而接受了梅毒治疗。5 名参与者在随后的就诊中被诊断为梅毒，1 名参与者失访。