Evaluation of between-assay consistency among laboratory testing methods for neurosyphilis: a systematic review
Xu Zhang
A , Fang-Zhi Du A , Qian-Qiu Wang A * and Rui-Li Zhang B *
A Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing 210042, China.
B Department of Dermatology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China.
Abstract
We conducted a systematic review to analyse the consistency of nontreponemal-specific tests of Treponema pallidum in cerebrospinal fluid. We searched the PubMed, EMBASE, Web of Science, CNKI, Wanfang and Chongqing VIP databases. The inclusion criteria were studies conducted on nontreponemal-specific tests in cerebrospinal fluid (CSF) within the same population. Exclusion criteria were studies with incomplete data or where we were unable to obtain the full text, duplicate reports, case reports and studies without sensitivity or specificity results. We used kappa value analysis and McNemar’s test to analyse study consistency. We initially collected a total of 198 articles and ultimately included six articles that involved 429 patients with neurosyphilis. The performance between venereal disease research laboratory tests (VDRL) and the reactive plasma regain or toluidine red serum unheated test was similar. The kappa value for consistency between VDRL and reactive plasma regain was >0.8 in three articles, and was 0.892 for consistency between VDRL and toluidine red serum unheated test in one article. Our results suggested that CSF-reactive plasma regain or CSF-toluidine red serum unheated test may serve as alternative tests in the diagnosis of neurosyphilis with CSF-VDRL.
Keywords: consistency, CSF, diagnosis, neurosyphilis, review, RPR, TRUST, VDRL.
References
1 Ropper AH. Neurosyphilis. N Engl J Med 2019; 381(14): 1358-63.
| Crossref | Google Scholar |
2 National Center for STD Control, Chinese Center for Disease Control and Prevention; Venereology Group, Chinese Society of Dermatology; Subcommittee on Venereology, China Dermatologist Association. Guidelines for diagnosis and treatment of syphilis, gonorrhea and genital chlamydia trachomatis infections (2020). Chin J Dermatol 2020; 53: 168-79.
| Crossref | Google Scholar |
3 Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep 2021; 70(4): 1-187.
| Crossref | Google Scholar |
4 Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin Microbiol Rev 1995; 8(1): 1-21.
| Crossref | Google Scholar |
5 Satyaputra F, Hendry S, Braddick M, Sivabalan P, Norton R. The laboratory diagnosis of syphilis. J Clin Microbiol 2021; 59(10): e0010021.
| Crossref | Google Scholar |
6 Versiani I, Cabral-Castro MJ, Puccioni-Sohler M. A comparison of nontreponemal tests in cerebrospinal fluid for neurosyphilis diagnosis: equivalent detection of specific antibodies. Arq Neuropsiquiatr 2019; 77(2): 91-5.
| Crossref | Google Scholar |
7 Zhu L, Gu X, Peng RR, Wang C, Gao Z, Zhou P, et al. Comparison of the cerebrospinal fluid (CSF) toluidine red unheated serum test and the CSF rapid plasma reagin test with the CSF venereal disease research laboratory test for diagnosis of neurosyphilis among HIV-negative syphilis patients in China. J Clin Microbiol 2014; 52(3): 736-40.
| Crossref | Google Scholar |
8 Castro R, Prieto ES, da Luz Martins Pereira F. Nontreponemal tests in the diagnosis of neurosyphilis: an evaluation of the Venereal Disease Research Laboratory (VDRL) and the Rapid Plasma Reagin (RPR) tests. J Clin Lab Anal 2008; 22(4): 257-61.
| Crossref | Google Scholar |
9 Marra CM, Tantalo LC, Maxwell CL, Ho EL, Sahi SK, Jones T. The rapid plasma reagin test cannot replace the venereal disease research laboratory test for neurosyphilis diagnosis. Sex Transm Dis 2012; 39(6): 453-7.
| Crossref | Google Scholar |
10 Lin L, Yang R, Zhang X, Xu L, Song W, Bi C, et al. Comparisons of several laboratory tests in the diagnosis of neurosyphilis. Chin J Dermatol 2011; 44(2): 127-9.
| Google Scholar |
11 Jiang Y, Chen X, Ma X, Yang Y, Peng F, Hu X. The usefulness of toluidine red unheated serum test in the diagnosis of HIV-negative neurosyphilis. Sex Transm Dis 2011; 38(3): 244-5.
| Crossref | Google Scholar |
12 Gu W, Yang Y, Wu L, Yang S, Ng L-K. Comparing the performance characteristics of CSF-TRUST and CSF-VDRL for syphilis: a cross-sectional study. BMJ Open 2013; 3(2): e002204.
| Crossref | Google Scholar |
