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Abstract:

and represent two clusters of the phylum that are either pathogenic or human host associated. subsp. , , and are the agents of venereal syphilis, endemic syphilis, and yaws, respectively, while causes pinta. Numerous treponemal phylotypes in the oral cavity cause gingivitis or periodontitis. , , and cause human intestinal spirochetosis. subsp. is the only treponeme transmitted by sexual contact and vertically from a pregnant woman to her fetus; it is alsoe only pathogenic treponeme that regularly breaches the blood-brain barrier. Venereal syphilis remains a significant public health problem worldwide. Methods of laboratory identification of both and include direct detection methods such as dark-field microscopy, immunohistochemistry, and PCR. However, while can be cultured, syphilis diagnosis is highly dependent on serologic testing since can only be isolated by inoculation of rabbits (rabbit infectivity testing). Serologic testing for syphilis involves nontreponemal tests that detect antibodies directed against lipoidal antigens and treponemal tests that detect IgM and IgG antibodies directed against protein antigens. Newer treponemal assays now include enzyme immunoassays, point-of-care tests, chemiluminescence assays, immunoblots, and multiplex flow immunoassays, the majority of which use recombinant antigens. In-depth knowledge of these assays and their performance, as well as the application of the reverse syphilis screening algorithm, is critical for both laboratory and clinical practice.

Citation: SeÑa A, Pillay A, Cox D, Radolf J. 2015. , p 1055-1081. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch60
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FIGURE 1

Morphology of . (A) Scanning electron micrograph showing spiral shape. (B) Negatively stained view of the tips of two organisms. Note the insertion points (I) of periplasmic flagella (PF) near the ends. (C to E) Electron micrographs of ultrathin sections, showing the outer membrane (OM), the cytoplasmic membrane (CM), periplasmic flagella (PF), and the location of the cytoplasmic filaments (CF). Bars, 0.1 μm. Reprinted with permission of Kluwer from . doi:10.1128/9781555817381.ch60.f1

Citation: SeÑa A, Pillay A, Cox D, Radolf J. 2015. , p 1055-1081. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch60
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Image of FIGURE 2
FIGURE 2

Human intestinal spirochetosis. (Top) H&E staining of a colonic biopsy sample showing a false brush border covering the luminal surface of the colon as observed by light microscopy. Reproduced with permission of Blackwell Publishing Asia Pty Ltd. from . (Bottom) Transmission electron micrograph showing attached end-on to the colonic mucosa, forming a false brush border. Magnification, ×11,000. Reproduced with permission of the American Society for Microbiology from . doi:10.1128/9781555817381.ch60.f2

Citation: SeÑa A, Pillay A, Cox D, Radolf J. 2015. , p 1055-1081. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch60
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Image of FIGURE 3
FIGURE 3

The natural course of untreated syphilis. Reprinted with permission of Appleton & Lange from . doi:10.1128/9781555817381.ch60.f3

Citation: SeÑa A, Pillay A, Cox D, Radolf J. 2015. , p 1055-1081. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch60
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FIGURE 4

PCR-based molecular typing of “street strains.” (Top) Schematic representation of all gene MseI RFLP patterns identified to date. Reproduced with permission of Springer from . (Bottom) Schematic showing different repeat sizes obtained by PCR. Molecular weight markers in base pairs are shown to the left in each panel. In panel B, the size of each repeat is indicated above the amplicon. doi:10.1128/9781555817381.ch60.f4

Citation: SeÑa A, Pillay A, Cox D, Radolf J. 2015. , p 1055-1081. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch60
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Tables

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TABLE 1

Characteristics and major clinical features of the treponematoses

Citation: SeÑa A, Pillay A, Cox D, Radolf J. 2015. , p 1055-1081. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch60
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TABLE 2

Clinical and laboratory criteria for diagnosis of syphilis (case definitions)

Citation: SeÑa A, Pillay A, Cox D, Radolf J. 2015. , p 1055-1081. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch60
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TABLE 3

Laboratory tests used for direct detection of in clinical samples obtained during the various stages of syphilis

Citation: SeÑa A, Pillay A, Cox D, Radolf J. 2015. , p 1055-1081. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch60
Generic image for table
TABLE 4

Oligonucleotide primers and probes used for real-time multiplex PCR for GUD

Citation: SeÑa A, Pillay A, Cox D, Radolf J. 2015. , p 1055-1081. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch60
Generic image for table
TABLE 5

Primers and thermocycling conditions for - and -specific PCR

Citation: SeÑa A, Pillay A, Cox D, Radolf J. 2015. , p 1055-1081. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch60
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TABLE 6

Nontreponemal tests for syphilis serodiagnosis

Citation: SeÑa A, Pillay A, Cox D, Radolf J. 2015. , p 1055-1081. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch60
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TABLE 7

Conventional treponemal tests for syphilis

Citation: SeÑa A, Pillay A, Cox D, Radolf J. 2015. , p 1055-1081. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch60
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TABLE 8

Treponemal IgM or IgG EIAs for syphilis

Citation: SeÑa A, Pillay A, Cox D, Radolf J. 2015. , p 1055-1081. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch60
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TABLE 9

Combined treponemal IgM/IgG EIAs for syphilis

Citation: SeÑa A, Pillay A, Cox D, Radolf J. 2015. , p 1055-1081. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch60
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TABLE 10

Rapid treponemal tests for syphilis

Citation: SeÑa A, Pillay A, Cox D, Radolf J. 2015. , p 1055-1081. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch60
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TABLE 11

Rapid combination nontreponemal and treponemal tests for syphilis

Citation: SeÑa A, Pillay A, Cox D, Radolf J. 2015. , p 1055-1081. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch60
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TABLE 12

Treponemal immunoblot assays for syphilis

Citation: SeÑa A, Pillay A, Cox D, Radolf J. 2015. , p 1055-1081. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch60
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TABLE 13

Treponemal chemiluminescence assays and multiplex flow immunoassays for syphilis

Citation: SeÑa A, Pillay A, Cox D, Radolf J. 2015. , p 1055-1081. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch60

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