Performance of the nontreponemal tests and treponemal tests on cerebrospinal fluid for the diagnosis of neurosyphilis: A meta-analysis

Jia-Wen Xie; Mao Wang; Ya-Wen Zheng; Yong Lin; Yun He; Li-Rong Lin

doi:10.3389/fpubh.2023.1105847

Performance of the nontreponemal tests and treponemal tests on cerebrospinal fluid for the diagnosis of neurosyphilis: A meta-analysis

Front Public Health. 2023 Feb 2:11:1105847. doi: 10.3389/fpubh.2023.1105847. eCollection 2023.

Authors

Jia-Wen Xie^{1

2}, Mao Wang^{1

2}, Ya-Wen Zheng^{1

2}, Yong Lin^{1

2}, Yun He^{1

2}, Li-Rong Lin^{1

2}

Affiliations

¹ Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital of Xiamen University, Xiamen University, Xiamen, China.
² School of Medicine, Institute of Infectious Disease, Xiamen University, Xiamen, China.

Abstract

Background: Nontreponemal and treponemal tests for analyzing cerebrospinal fluid to confirm the existence of neurosyphilis have been widely used, so we aim to evaluate and compare their performance on the cerebrospinal fluid in the diagnosis of neurosyphilis.

Methods: We conducted a systematic literature search on five databases and utilized a bivariate random-effects model to perform the quantitative synthesis.

Results: Nontreponemal tests demonstrated a pooled sensitivity of 0.77 (95% CI: 0.68-0.83), a pooled specificity of 0.99 (95% CI: 0.97-1.00), and a summary AUC of 0.97 (95% CI: 0.95-0.98). The pooled sensitivity, pooled specificity, and summary AUC of treponemal tests were 0.95 (95% CI: 0.90-0.98), 0.85 (95% CI: 0.67-0.94), and 0.97 (95% CI: 0.95-0.98), respectively. The pooled specificity of all nontreponemal tests varied minimally (ranging from 0.97 to 0.99), with TRUST (0.83) having a higher pooled sensitivity than VDRL (0.77) and RPR (0.73). Among all treponemal tests, EIA has outstanding diagnostic performance with a pooled sensitivity of 0.99 and a pooled specificity of 0.98.

Conclusion: Nontreponemal tests exhibited a higher pooled specificity, and treponemal tests exhibited a higher pooled sensitivity in diagnosing neurosyphilis on cerebrospinal fluid. TRUST may be a satisfactory substitute for VDRL. EIA is a prospective diagnostic tool that deserves further study in the future. Our study may be useful to clinical laboratories in selecting appropriate serological tests on the cerebrospinal fluid for the diagnosis of neurosyphilis.

Keywords: diagnostic performance; neurosyphilis; nontreponemal tests; serological assays; treponemal tests.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Data Management
Humans
Neurosyphilis* / cerebrospinal fluid
Neurosyphilis* / diagnosis
Prospective Studies
Syphilis Serodiagnosis
Treponema pallidum*

Grants and funding

This work was supported by the National Natural Science Foundation of China [grant numbers 82172331, 81972028, and 81672094] and the Key Projects for Province Science and Technology Program of Fujian Province, China [grant number 2020D017]. The funders played no role in the study design, data collection, analyses, the decision to publish, or manuscript preparation.