Table A6.3, Detection of syphilis using clinical diagnosis of syphilis in a population of individuals with genital ulcer disease - Guidelines for the management of symptomatic sexually transmitted infections

Study	Year of study	Country	Country income level	Sample size	Where recruited	Subpopulation	How a positive case is defined	Diagnostics	True positive	False negative	False positive	True negative
Behets et al. (8)	1997	Madagascar	Low	196	Sexual health clinic	71% men	Clinical diagnosis^a	M-PCR	52	4	112	28
Behets et al. (9)	1996	Jamaica	Upper middle	304	Sexual Health clinic	83% men	Clinical diagnosis^a	M-PCR	21	10	24	249
Beyrer et al. (10)	1995–1996	Thailand	Upper middle	38	Sexual health clinic	79% female sex workers	Clinical diagnosis^a	M-PCR	0	1	1	36
Bhavsar et al. (11)	2011–2012	India	Lower middle	96	Hospital	79% men	Clinical diagnosis^a	VDRL, TPHA	19	24	1	52
Bogaerts et al. (12)	1990–1992	Rwanda	Low	395	General practice	63% men	History and examination	RPR, TPHA, Darkfield microscopy	108	2	279	6
Bogaerts et al. (12)	1990–1992	Rwanda	Low	395	General practice	63% men	History and examination + syphilis serology or darkfield microscopy	RPR, TPHA, Darkfield microscopy	107	3	9	276
Bogaerts et al. (12)	1990–1992	Rwanda	Low	395	General practice	63% men	Clinical diagnosis^a	RPR, TPHA, Darkfield microscopy	20	90	31	254
DiCarlo & Martin (13)	1990–1992	United States	High	220	Sexual health clinic	100% men	Clinical diagnosis^a	Darkfield microscopy	14	31	3	172
Hanson et al. (22)	1996	Zambia	Lower middle	95	Hospital	100% men	Clinical diagnosis^a	Darkfield microscopy, RPR, TPHA	24	17	14	40
Hanson et al. (22)	1996	Zambia	Lower middle	131	Hospital	100% women	Clinical diagnosis^a	Darkfield microscopy, RPR, TPHA	14	22	12	83
Htun et al. (15)	1993–1994	Lesotho	Lower middle	92	Sexual health clinic		Clinical diagnosis^a	MPCR, RPR, FTA-Abs	5	18	1	68
Htun et al. (15)	1993–1994	Lesotho	Lower middle	92	Sexual health clinic		Clinical diagnosis^a	MPCR, RPR, FTA-Abs	30	4	52	6
Htun et al. (15)	1993–1994	Lesotho	Lower middle	92	Sexual health clinic		Clinical diagnosis^a	MPCR, RPR, FTA-Abs	33	1	52	6
Ndinya-Achola et al. (23)	1990–1991	Kenya	Lower middle	172	Primary care	47% men	Clinical diagnosis^a	RPR	6	18	19	129
Prabhakar et al. (16)	2008–2009	India	Lower middle	181	Sexual health clinic	100% men	Clinical diagnosis^a	M-PCR	26	18	72	78
Sanchez et al. (7)	1995–1996	Dominican Republic	Upper middle	81	General practice	100% men	Clinical diagnosis^a	M-PCR	2	2	11	66
Sanchez et al. (7)	1995–1996	Dominican Republic	Upper middle	63	General practice	100% men	Clinical diagnosis^a	M-PCR	2	4	8	49
Wang et al. (18)	1998–1999	China	Upper middle	96	Sexual health clinic	100% had “STI symptoms”	Clinical diagnosis^a	M-PCR, RPR, TPPA	18	5	12	61
Wang et al. (19)	2000–1	China	Upper middle	227	Sexual health clinic	90% men	Symptoms + examination + risk factors	M-PCR, Darkfield microscopy, RPR, TPPA	94	12	6	115
Fast et al. (20)	1980	Kenya	Lower middle	70	“Special treatment clinic”	100% men	Clinical diagnosis^a	RPR, Darkfield microscopy	6	4	4	56
Dangor et al. (21)	Unclear	South Africa	Upper middle	210	Hospital	100% male	Clinical diagnosis^a	RPR, fluorescent treponemal antibody absorption, darkfield microscopy	22	3	25	160

Study

Year of study

Country

Country income level

Sample size

Where recruited

Subpopulation

How a positive case is defined

Diagnostics

True positive

False negative

False positive

True negative

Behets et al. (8)

1997

Madagascar

Low

196

Sexual health clinic

71% men

Clinical diagnosis^a

M-PCR

112

Behets et al. (9)

1996

Jamaica

Upper middle

304

Sexual Health clinic

83% men

Clinical diagnosis^a

M-PCR

249

Beyrer et al. (10)

1995–1996

Thailand

Upper middle

Sexual health clinic

79% female sex workers

Clinical diagnosis^a

M-PCR

Bhavsar et al. (11)

2011–2012

India

Lower middle

Hospital

79% men

Clinical diagnosis^a

VDRL, TPHA

Bogaerts et al. (12)

1990–1992

Rwanda

Low

395

General practice

63% men

History and examination

RPR, TPHA, Darkfield microscopy

108

279

Bogaerts et al. (12)

1990–1992

Rwanda

Low

395

General practice

63% men

History and examination + syphilis serology or darkfield microscopy

RPR, TPHA, Darkfield microscopy

107

276

Bogaerts et al. (12)

1990–1992

Rwanda

Low

395

General practice

63% men

Clinical diagnosis^a

RPR, TPHA, Darkfield microscopy

254

DiCarlo & Martin (13)

1990–1992

United States

High

220

Sexual health clinic

100% men

Clinical diagnosis^a

Darkfield microscopy

172

Hanson et al. (22)

1996

Zambia

Lower middle

Hospital

100% men

Clinical diagnosis^a

Darkfield microscopy, RPR, TPHA

Hanson et al. (22)

1996

Zambia

Lower middle

131

Hospital

100% women

Clinical diagnosis^a

Darkfield microscopy, RPR, TPHA

Htun et al. (15)

1993–1994

Lesotho

Lower middle

Sexual health clinic

Clinical diagnosis^a

MPCR, RPR, FTA-Abs

Htun et al. (15)

1993–1994

Lesotho

Lower middle

Sexual health clinic

Clinical diagnosis^a

MPCR, RPR, FTA-Abs

Htun et al. (15)

1993–1994

Lesotho

Lower middle

Sexual health clinic

Clinical diagnosis^a

MPCR, RPR, FTA-Abs

Ndinya-Achola et al. (23)

1990–1991

Kenya

Lower middle

172

Primary care

47% men

Clinical diagnosis^a

RPR

129

Prabhakar et al. (16)

2008–2009

India

Lower middle

181

Sexual health clinic

100% men

Clinical diagnosis^a

M-PCR

Sanchez et al. (7)

1995–1996

Dominican Republic

Upper middle

General practice

100% men

Clinical diagnosis^a

M-PCR

Sanchez et al. (7)

1995–1996

Dominican Republic

Upper middle

General practice

100% men

Clinical diagnosis^a

M-PCR

Wang et al. (18)

1998–1999

China

Upper middle

Sexual health clinic

100% had “STI symptoms”

Clinical diagnosis^a

M-PCR, RPR, TPPA

Wang et al. (19)

2000–1

China

Upper middle

227

Sexual health clinic

90% men

Symptoms + examination + risk factors

M-PCR, Darkfield microscopy, RPR, TPPA

115

Fast et al. (20)

1980

Kenya

Lower middle

“Special treatment clinic”

100% men

Clinical diagnosis^a

RPR, Darkfield microscopy

Dangor et al. (21)

Unclear

South Africa

Upper middle

210

Hospital

100% male

Clinical diagnosis^a

RPR, fluorescent treponemal antibody absorption, darkfield microscopy

160

From: ANNEX 6, EVIDENCE-TO-DECISION TABLE: GENITAL ULCER DISEASE

Cover of Guidelines for the management of symptomatic sexually transmitted infections

Guidelines for the management of symptomatic sexually transmitted infections [Internet].

Geneva: World Health Organization; 2021 Jun.

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Table A6.3Detection of syphilis using clinical diagnosis of syphilis in a population of individuals with genital ulcer disease