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• W4387078218 abstract "Syphilis is a chronic sexually transmitted disease caused by Treponema pallidum (T. pallidum).1 Diagnosis usually relies on detection of serum antibodies rather than of T. pallidum, which limits the assessment of prognosis. Metagenomic next-generation sequencing (mNGS) allows the sequence-based detection of bacteria, viruses, fungi, and parasites in clinical samples.2 mNGS has been increasingly used in clinical microbiology, especially for diagnosis of rare or complex infectious diseases, but its application to syphilis remains unclear. The current prospective study enrolled patients with a diagnosis of early-stage syphilis to assess the diagnostic and prognostic value of NGS technology. A total of 16 patients with a clinical diagnosis of early-stage syphilis admitted to the Affiliated Lianyungang Hospital of Xuzhou Medical University between September 2022 and February 2023 were enrolled. Diagnoses were made by two dermatologists based on the patient's history, clinical presentation, treponema pallidum particle agglutination (TPPA), and rapid plasma reagin (RPR) test results. All patients received a positive TPPA result and an RPR result between 1 : 16 and 1 : 128. The recommended two doses of penicillin were given and no signs of allergy recorded.3 Peripheral blood samples were collected before treatment and at 1, 2, and 4 weeks post-treatment and mNGS performed by Nanjing BGI laboratory. mNGS performed prior to treatment indicated that 15 out of 16 patients had T. pallidum infection; nine tested negative by mNGS after 1 week of treatment; 13 were negative after 2 weeks of treatment, and all 15 were negative after 4 weeks of treatment. The sensitivity of mNGS was high at 93.75% (15/16). We consider NGS to be a potential complementary tool for differential diagnosis of syphilis. The single patient who tested negative by mNGS prior to treatment may have had a very low serum pathogen load in the initial stage of T. pallidum infection. This observation serves to emphasize the importance of considering the clinical and epidemiological background and that the final clinical diagnosis should be used as the gold standard. Evaluation of the infectivity load has great value for the practical needs of medical treatment. The treponemal-specific test, TPPA, is commonly used for diagnosis and simple low-cost non-treponemal tests, such as RPR and TRUST, for assessment of syphilis efficacy, recurrence, or reinfection. However, such assessments present difficulties for early-stage syphilis. Penicillin is known to be effective against syphilis, and the early-stage syphilis patients of the current cohort tested negative by mNGS after two doses of penicillin, indicating that T. pallidum levels were greatly reduced. We suspect that post penicillin, patients are much less infectious even when positive RPR results are found. The results of the current study suggest the suitability of mNGS as a complementary tool for diagnosis and assessment of prognosis in early-stage syphilis. We acknowledge some shortcomings in the current research. First, the sample size was small, precluding an analysis of all stages of syphilis. Larger scale studies are required in the future. Second, mNGS is expensive and requires specialized equipment, making it suitable as a supplement to serological methods for syphilis detection." @default.
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• W4387078218 date "2023-09-27" @default.
• W4387078218 modified "2023-10-14" @default.
• W4387078218 title "Next‐generation sequencing for diagnosis and prognosis in early‐stage syphilis" @default.
• W4387078218 cites W2898604559 @default.
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• W4387078218 doi "https://doi.org/10.1111/ijd.16864" @default.
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