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Early Syphilis: New Diagnostic Approaches in a Changing Scenario
Sífilis precoz: nuevas aproximaciones diagnósticas para un escenario cambiante
T. Toledo Pastrana
Unidad de Gestión Clínica de Dermatología, Servicio de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Toledo Pastrana" "autores" => array:1 [ 0 => array:3 [ "nombre" => "T." "apellidos" => "Toledo Pastrana" "email" => array:1 [ 0 => "ttoledop@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Gestión Clínica de Dermatología, Servicio de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sífilis precoz: nuevas aproximaciones diagnósticas para un escenario cambiante" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Syphilis affects millions of people each year, and its incidence has increased year on year over the last 10 years. Traditionally, the diagnostic algorithm for syphilis started with a nontreponemal test (NTT) (rapid plasma reagin [RPR] test or Venereal Disease Research Laboratory [VDRL] test). Only if one of these tests was positive would specific treponemal tests (TTs) (<span class="elsevierStyleItalic">Treponema pallidum</span> hemagglutination, fluorescent treponemal antibody absorption, or <span class="elsevierStyleItalic">T. pallidum</span> particle agglutination tests) be requested for confirmation. In recent years, automated treponemal tests (enzyme-linked immunoassay [EIA] and chemiluminescent immunoassay [CLIA]) have been developed, with high sensitivity, rapid test performance, and observer-independent results. These tests should now be considered for use as screening tools, especially as they are inexpensive.</p><p id="par0010" class="elsevierStylePara elsevierViewall">These developments have led to replacement of the traditional diagnostic algorithm for syphilis (NTTs first then TTs) with others that place emphasis on the automated treponemal tests. Such an algorithm is proposed by the European Centre for Disease Prevention and Control (ECDP) in its most recent update to the guidelines. The recommendation now is to start with an automated TT (EIA and CLIA) and subsequently perform a quantitative NTT (RPR). If the NTT is negative, a second TT different to the one previously used for screening is employed.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The new automated techniques also allow measurement of IgM and IgG antibodies specific for <span class="elsevierStyleItalic">T. pallidum</span>, which is of particular interest for monitoring therapeutic response as IgM levels decrease rapidly after suitable treatment; these tests are particularly useful for follow-up of response in patients with HIV coinfection.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">It is essential that dermatologists be aware of the important progress in diagnostic tests and the resulting changes in the diagnostic algorithm for syphilis. The study by García-Legaz Martínez et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> highlights how these new diagnostic approaches are extremely useful in everyday clinical practice. Our obligation is to keep up to date in this field, not only because venereology is an essential part of our specialty, but also to avoid mistaken interpretations in tests requested, or diagnostic errors or inappropriate follow-up of our patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Toledo-Pastrana T. Sífilis precoz: nuevas aproximaciones diagnósticas para un escenario cambiante. Actas Dermosifiliogr. 2020;111:87–88.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Analysis of 3 algorithms for syphilis serodiagnosis and implications for clinical management" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.L. Tong" 1 => "L.R. Lin" 2 => "L.L. Liu" 3 => "H.L. Zhang" 4 => "S.J. Huang" 5 => "Y.Y. Chen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/ciu087" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2014" "volumen" => "58" "paginaInicial" => "1116" "paginaFinal" => "1124" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24550376" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European guideline on the management of syphilis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Janier" 1 => "V. Hegyi" 2 => "N. Dupin" 3 => "M. Unemo" 4 => "G.S. Tiplica" 5 => "M. Potočnik" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jdv.12734" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2014" "volumen" => "28" "paginaInicial" => "1581" "paginaFinal" => "1593" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25348878" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utilidad de las nuevas pruebas treponémicas automatizadas en el diagnóstico de sífilis precoz. A propósito de 15 casos" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. García-Legaz Martínez" 1 => "P. Hernández-Bel" 2 => "J. Magdaleno-Tapial" 3 => "A. Martínez-Doménech" 4 => "D. Navalpotro" 5 => "V. Alegre-de Miquel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2020" "volumen" => "111" "paginaInicial" => "135" "paginaFinal" => "142" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011100000002/v1_202004140647/S1578219020300135/v1_202004140647/en/main.assets" "Apartado" => array:4 [ "identificador" => "66476" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Commentaries" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011100000002/v1_202004140647/S1578219020300135/v1_202004140647/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020300135?idApp=UINPBA000044" ]
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