(P406) The Utility of Biomarkers in the Clinical Management of Syphilis: A Systematic Review

The Utility of Biomarkers in the Clinical Management of Syphilis: A Systematic Review

Zachary W. Lorenz, MD, Sukhjeevan Nijhar, BS, Christine Caufield-Noll, Khalil G. Ghanem, MD, PhD, Matthew M. Hamill, MBChB, PhD

Background

Routinely available laboratory tests for the management of Treponema pallidum infections have significant limitations. High performance biomarkers can improve diagnostic confidence and clinical management of syphilis at different stages of infection. We conducted a systematic review to examine the utility of biomarkers in the diagnosis and management of syphilis.

Methods

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to identify articles for inclusion and three reviewers independently reviewed them for eligibility and study quality using a three-stage procedure. The search, conducted by a senior library informationist, used PubMed, Embase, Cochrane Library, and Scopus and included any study published prior to May 2022. The following syphilis outcomes were assessed: primary and secondary syphilis, neurological syphilis, congenital syphilis, the serofast state, syphilis in persons living with HIV, and syphilis reinfection.

Results

Of the 111 studies identified, 31 (27.9%) were included in our review. Most studies were cross-sectional or prospective. Table 1 summarizes the various biomarkers used for each of the syphilis outcomes. The data were strikingly heterogeneous, using different methodologies and definitions for the outcomes of interest. The most consistent data were for the biomarker CXCL-13 (C-X-C Motif Chemokine Ligand 13) in the diagnosis of neurological syphilis, but even that biomarker had limitations.

Conclusions

Available data do not support the use of any existing novel biomarker to aid clinical decision-making in syphilis management. The syphilis biomarker literature is heterogenous and lacks measurement of clinically meaningful endpoints. We recommend the formation of a working group to set priorities for syphilis biomarker research and to guide future study using clinically meaningful biomarkers.