BACKGROUND: Syphilis continues to be a public health problem, and its diagnosis
still has limitations. Molecular diagnosis provides an alternative for rapid and
effective management. The objective is to determine the accuracy of tests in the
molecular diagnosis of syphilis.
METHODS: We searched PubMed and Web of Sciences for articles related to
molecular detection of syphilis from January 1, 2009, to December 31, 2019. The
bivariate Reitsma model and the hierarchical receiver operating characteristic
curve model were used to evaluate the diagnostic performance of molecular tests
at a 95% confidence interval. A subgroup meta-analysis was performed to explore
sources of heterogeneity.
RESULTS: Forty-seven articles were identified for qualitative synthesis, of
which 23 met the inclusion criteria for meta-analysis. The pooled sensitivities
in conventional polymerase chain reaction (PCR) and real-time PCR were 77.52
(59.50-89.01) and 68.43 (54.96-79.39), respectively. The pooled specificities
were 98.00 (90.73-99.59) and 98.84 (97.55-99.46), respectively. Ulcer samples
had a better performance (sensitivity of 79.88 [69.00-87.62] and specificity of
98.58 [97.25-99.27]), and the major target genes were the polymerase A gene and
tpp47 gene.
CONCLUSIONS: Our work showed that conventional PCR was more widely used than
real-time PCR in the diagnosis of syphilis, and ulcers were the best specimens.
Sample types and target genes are factors that may influence the quality of the
different tests. These results could provide evidence for further work in the
direction of providing a more efficient diagnostic test.

Seroprevalence, transfusion-transmissible infections