{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T10:04:24Z","timestamp":1784369064529,"version":"3.55.0"},"reference-count":28,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T00:00:00Z","timestamp":1784332800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T00:00:00Z","timestamp":1784332800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Dermatology"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n \n Syphilis, caused by\n \n Treponema pallidum<\/jats:italic>\n <\/jats:styled-content>\n , is a re\u2010emerging sexually transmitted infection. The oropharynx may be a site of\n \n T. pallidum<\/jats:italic>\n <\/jats:styled-content>\n DNA detection, but real\u2010world data on the diagnostic performance and epidemiological relevance of pharyngeal polymerase chain reaction (PCR) are scarce.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We retrospectively analyzed 149 pharyngeal PCR testing episodes from 131 unique patients collected between 2018 and 2025. Seventy\u2010six testing episodes were classified as syphilis cases, defined by compatible clinical features, serology, and\/or PCR positivity at another site, along with 73 controls. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Results were contextualized through a literature review.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Pharyngeal PCR was positive in 38 of 76 syphilis cases (50%), with a specificity of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 65.8%. Positivity rates were 44.4% in primary syphilis, 55.8% in secondary syphilis, 55.6% in early latent syphilis, and 0% in late latent syphilis. Notably,\n \n T. pallidum<\/jats:italic>\n <\/jats:styled-content>\n DNA was detected in the pharynx of patients without oral lesions and in some primary syphilis cases with negative rapid plasma reagin (RPR), suggesting possible early oropharyngeal mucosal shedding. In contrast, certain palmoplantar lesions yielded negative PCR results despite concomitant pharyngeal positivity.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Pharyngeal PCR is a highly specific complementary diagnostic tool, particularly useful in early syphilis and in cases with discordant serology. Detection of\n \n T. pallidum<\/jats:italic>\n <\/jats:styled-content>\n DNA in the oropharynx, even without oral lesions, provides evidence of mucosal DNA shedding and suggests potential implications for transmission dynamics. However, PCR does not demonstrate viable organisms, and whether such DNA detection reflects organisms capable of transmission requires further study.\n <\/jats:p>\n \n \n \n image<\/jats:alt-text>\n <\/jats:graphic>\n <\/jats:boxed-text>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ijd.70591","type":"journal-article","created":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T09:17:37Z","timestamp":1784366257000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Oropharyngeal\n \n Treponema pallidum<\/i>\n DNA\n <\/scp>\n Detection in Early Syphilis: Diagnostic Yield of Pharyngeal\n PCR<\/scp>\n and Potential Implications for Mucosal Shedding"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7667-600X","authenticated-orcid":false,"given":"Daniel","family":"Blaya\u2010Imbern\u00f3n","sequence":"first","affiliation":[{"name":"Dermatology and Venereology Department Consortium General University Hospital of Valencia Val\u00e8ncia Spain"},{"name":"Medicine Department University of Valencia Val\u00e8ncia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0711-3481","authenticated-orcid":false,"given":"Malena","family":"Finello","sequence":"additional","affiliation":[{"name":"Dermatology and Venereology Department Consortium General University Hospital of Valencia Val\u00e8ncia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2557-3107","authenticated-orcid":false,"given":"Andr\u00e9s","family":"Grau\u2010Echevarr\u00eda","sequence":"additional","affiliation":[{"name":"Dermatology and Venereology Department Consortium General University Hospital of Valencia Val\u00e8ncia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3270-7428","authenticated-orcid":false,"given":"Carolina","family":"Labrandero\u2010Hoyos","sequence":"additional","affiliation":[{"name":"Dermatology and Venereology Department Consortium General University Hospital of Valencia Val\u00e8ncia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9627-780X","authenticated-orcid":false,"given":"Rodrigo","family":"Pe\u00f1uelas\u2010Leal","sequence":"additional","affiliation":[{"name":"Dermatology and Venereology Department Consortium General University Hospital of Valencia Val\u00e8ncia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5071-9369","authenticated-orcid":false,"given":"\u00c1ngel","family":"Gonz\u00e1lez\u2010Garc\u00eda","sequence":"additional","affiliation":[{"name":"Dermatology and Venereology Department Consortium General University Hospital of Valencia Val\u00e8ncia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6876-9877","authenticated-orcid":false,"given":"Elena","family":"P\u00e9rez\u2010Zafrilla","sequence":"additional","affiliation":[{"name":"Dermatology and Venereology Department Consortium General University Hospital of Valencia Val\u00e8ncia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5455-7122","authenticated-orcid":false,"given":"Alba","family":"N\u00e1cher\u2010Albiach","sequence":"additional","affiliation":[{"name":"Dermatology and Venereology Department Consortium General University Hospital of Valencia Val\u00e8ncia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6920-2384","authenticated-orcid":false,"given":"Laura","family":"Gim\u00e9nez\u2010Cuenca","sequence":"additional","affiliation":[{"name":"Dermatology and Venereology Department Consortium General University Hospital of Valencia Val\u00e8ncia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1231-8012","authenticated-orcid":false,"given":"Dolla","family":"Logunova","sequence":"additional","affiliation":[{"name":"Dermatology and Venereology Department Consortium General University Hospital of Valencia Val\u00e8ncia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Giner\u2010Cerd\u00e1","sequence":"additional","affiliation":[{"name":"Dermatology and Venereology Department Consortium General University Hospital of Valencia Val\u00e8ncia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0046-6962","authenticated-orcid":false,"given":"Jorge","family":"Magdaleno\u2010Tapial","sequence":"additional","affiliation":[{"name":"Dermatology and Venereology Department Consortium General University Hospital of Valencia Val\u00e8ncia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Diez\u2010Recio","sequence":"additional","affiliation":[{"name":"Dermatology and Venereology Department Consortium General University Hospital of Valencia Val\u00e8ncia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2546-105X","authenticated-orcid":false,"given":"Maria Dolores","family":"Ocete\u2010Monch\u00f3n","sequence":"additional","affiliation":[{"name":"Microbiology Department, Dermatology Consortium General University Hospital of Valencia Val\u00e8ncia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7515-0706","authenticated-orcid":false,"given":"David","family":"Navalpotro\u2010Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Medicine Department University of Valencia Val\u00e8ncia Spain"},{"name":"Microbiology Department Hospital Universitario y Polit\u00e9cnico La Fe Val\u00e8ncia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3093-6681","authenticated-orcid":false,"given":"Pablo","family":"Hern\u00e1ndez\u2010Bel","sequence":"additional","affiliation":[{"name":"Dermatology and Venereology Department Consortium General University Hospital of Valencia Val\u00e8ncia Spain"},{"name":"Medicine Department University of Valencia Val\u00e8ncia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,18]]},"reference":[{"issue":"15","key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"5308","DOI":"10.3390\/jcm14155308","article-title":"The Epidemiology of Syphilis Worldwide in the Last Decade","volume":"14","author":"Rosset F.","year":"2025","journal-title":"Journal of Clinical Medicine"},{"key":"e_1_2_9_3_1","doi-asserted-by":"crossref","DOI":"10.3389\/fmed.2024.1448841","article-title":"Global, Regional, and National Burden of Syphilis, 1990\u20132021 and Predictions by Bayesian Age\u2010Period\u2010Cohort Analysis: A Systematic Analysis for the Global Burden of Disease Study 2021","volume":"11","author":"Yu W.","year":"2024","journal-title":"Frontiers in Medicine (Lausanne)"},{"key":"e_1_2_9_4_1","volume-title":"ECDC. Annual Epidemiological Report for 2023","author":"European Centre for Disease Prevention and Control","year":"2025"},{"key":"e_1_2_9_5_1","volume-title":"Vigilancia epidemiol\u00f3gica de las infecciones de transmisi\u00f3n sexual, 2023","author":"Unidad de vigilancia de VIH, ITS y hepatitis B y C","year":"2024"},{"issue":"3","key":"e_1_2_9_6_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0279048","article-title":"Sexually Transmitted Infections Among Key Populations in India: A Protocol for Systematic Review","volume":"18","author":"Bhatta M.","year":"2023","journal-title":"PLoS One"},{"key":"e_1_2_9_7_1","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2022.908591","article-title":"Upward Trends of Syphilis in Non\u2010Pregnant Adults: A Six\u2010Year Report on the Clinical and Epidemiological Profile of Syphilis From a Tertiary Care Center, India","volume":"10","author":"Solaimalai D.","year":"2022","journal-title":"Frontiers in Public Health"},{"issue":"9","key":"e_1_2_9_8_1","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1093\/clinchem\/hvaf072","article-title":"Advances in Syphilis Diagnostics to Address the 21st\u2010Century Epidemic","volume":"71","author":"Treger R. S.","year":"2025","journal-title":"Clinical Chemistry"},{"issue":"2","key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.adengl.2020.01.002","article-title":"Usefulness of New Automated Treponemal Tests in the Diagnosis of Early Syphilis: A Series of 15 Cases","volume":"111","author":"Garc\u00eda\u2010Legaz Mart\u00ednez M.","year":"2020","journal-title":"Actas Dermo\u2010Sifiliogr\u00e1ficas"},{"issue":"8","key":"e_1_2_9_10_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0237949","article-title":"A Retrospective Study on Nested PCR Detection of Syphilis Treponemes in Clinical Samples: PCR Detection Contributes to the Diagnosis of Syphilis in Patients With Seronegative and Serodiscrepant Results","volume":"15","author":"Vrbov\u00e1 E.","year":"2020","journal-title":"PLoS One"},{"issue":"5","key":"e_1_2_9_11_1","doi-asserted-by":"crossref","DOI":"10.1128\/JCM.01782-17","article-title":"Retrospective Review of \n Treponema pallidum\n PCR and Serology Results: Are Both Tests Necessary?","volume":"56","author":"Brischetto A.","year":"2018","journal-title":"Journal of Clinical Microbiology"},{"issue":"1","key":"e_1_2_9_12_1","first-page":"e51","article-title":"Diagnostic Value of \n Treponema pallidum\n PCR Test in Real Practice","volume":"64","author":"Labrandero Hoyos C.","year":"2023","journal-title":"Australasian Journal of Dermatology"},{"issue":"1","key":"e_1_2_9_13_1","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.1093\/cid\/ciaa176","article-title":"Molecular and Direct Detection Tests for \n Treponema pallidum\n Subspecies Pallidum: A Review of the Literature, 1964\u20132017","volume":"71","author":"Theel E. S.","year":"2020","journal-title":"Clinical Infectious Diseases"},{"issue":"3","key":"e_1_2_9_14_1","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1128\/JCM.00702-11","article-title":"Evaluation of a PCR Test for Detection of \n Treponema pallidum\n in Swabs and Blood","volume":"50","author":"Grange P. A.","year":"2012","journal-title":"Journal of Clinical Microbiology"},{"issue":"9","key":"e_1_2_9_15_1","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1111\/j.1365-4632.2008.03617.x","article-title":"A Case of Extragenital Chancre on a Nipple From a Human Bite During Sexual Intercourse","volume":"47","author":"Oh Y.","year":"2008","journal-title":"International Journal of Dermatology"},{"issue":"4","key":"e_1_2_9_16_1","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1001\/jama.2012.7538","article-title":"A Crusted Plaque on the Right Nipple","volume":"308","author":"Chiu H. Y.","year":"2012","journal-title":"Journal of the American Medical Association"},{"key":"e_1_2_9_17_1","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1186\/s12879-021-06114-7","article-title":"Unusual Erythematous Plaque With White Scales, a Case of Acquired Syphilis in a Child and Literature Review","volume":"21","author":"Yang W. J.","year":"2021","journal-title":"BMC Infectious Diseases"},{"issue":"14","key":"e_1_2_9_18_1","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000003303","article-title":"Syphilitic Chancre of the Lips Transmitted by Kissing: A Case Report and Review of the Literature","volume":"95","author":"Yu X.","year":"2016","journal-title":"Medicine (Baltimore)"},{"issue":"41","key":"e_1_2_9_19_1","first-page":"966","article-title":"Transmission of Primary and Secondary Syphilis by Oral Sex\u2014Chicago, Illinois, 1998\u20132002","volume":"53","author":"Centers for Disease Control and Prevention (CDC)","year":"2004","journal-title":"MMWR. Morbidity and Mortality Weekly Report"},{"issue":"11","key":"e_1_2_9_20_1","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1097\/OLQ.0000000000001867","article-title":"Changes in Oral and Anal Sex With Opposite\u2010Sex Partners Among Sexually Active Females and Males Aged 15 to 44\u2009Years in the United States: National Survey of Family Growth, 2011\u20132019","volume":"50","author":"Katz D. A.","year":"2023","journal-title":"Sexually Transmitted Diseases"},{"issue":"8","key":"e_1_2_9_21_1","doi-asserted-by":"crossref","first-page":"787.e1","DOI":"10.1016\/j.cmi.2015.04.018","article-title":"Unexpectedly High Prevalence of \n Treponema pallidum\n Infection in the Oral Cavity of HIV\u2010Infected Patients With Early Syphilis Who Had Engaged in Unprotected Sex Practices","volume":"21","author":"Yang C. J.","year":"2015","journal-title":"Clinical Microbiology and Infection"},{"issue":"8","key":"e_1_2_9_22_1","doi-asserted-by":"crossref","DOI":"10.1128\/JCM.00572-19","article-title":"Treponema pallidum\n Nucleic Acid Amplification Testing to Augment Syphilis Screening Among Men Who Have Sex With Men","volume":"57","author":"Golden M.","year":"2019","journal-title":"Journal of Clinical Microbiology"},{"issue":"9","key":"e_1_2_9_23_1","doi-asserted-by":"crossref","first-page":"e3250","DOI":"10.1093\/cid\/ciaa1613","article-title":"A New Specimen for Syphilis Diagnosis: Evidence by High Loads of \n Treponema pallidum\n DNA in Saliva","volume":"73","author":"Wang C.","year":"2021","journal-title":"Clinical Infectious Diseases"},{"issue":"12","key":"e_1_2_9_24_1","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1097\/OLQ.0000000000001476","article-title":"Detection of \n Treponema pallidum\n DNA in Oropharyngeal Swabs and Whole Blood for Syphilis Diagnosis","volume":"48","author":"Tantalo L. C.","year":"2021","journal-title":"Sexually Transmitted Diseases"},{"issue":"9","key":"e_1_2_9_25_1","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1016\/S1473-3099(20)30838-0","article-title":"Treponema pallidum\n Detection in Lesion and Non\u2010Lesion Sites in Men Who Have Sex With Men With Early Syphilis: A Prospective, Cross\u2010Sectional Study","volume":"21","author":"Towns J. M.","year":"2021","journal-title":"Lancet Infectious Diseases"},{"issue":"10","key":"e_1_2_9_26_1","first-page":"2083","article-title":"Treponema pallidum\n Detection at Asymptomatic Oral, Anal, and Vaginal Sites in Adults Reporting Sexual Contact With Persons With Syphilis","volume":"29","author":"Aung E. T.","year":"2023","journal-title":"Emerging Infectious Diseases"},{"issue":"6","key":"e_1_2_9_27_1","doi-asserted-by":"crossref","first-page":"1628","DOI":"10.1093\/infdis\/jiad582","article-title":"Prevalence and Predictors of Oral \n Treponema pallidum\n Detection by Quantitative Polymerase Chain Reaction in Early Syphilis","volume":"229","author":"Dionne J. A.","year":"2024","journal-title":"Journal of Infectious Diseases"},{"issue":"12","key":"e_1_2_9_28_1","doi-asserted-by":"crossref","DOI":"10.1128\/jcm.00809-24","article-title":"Prospective Evaluation of Non\u2010Invasive Saliva Specimens for the Diagnosis of Syphilis and Molecular Surveillance of \n Treponema pallidum","volume":"62","author":"Imai K.","year":"2024","journal-title":"Journal of Clinical Microbiology"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans\u20102025\u2010056712"}],"container-title":["International Journal of Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ijd.70591","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ijd.70591","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ijd.70591","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T09:17:41Z","timestamp":1784366261000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ijd.70591"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,18]]},"references-count":28,"alternative-id":["10.1111\/ijd.70591"],"URL":"https:\/\/doi.org\/10.1111\/ijd.70591","archive":["Portico"],"relation":{},"ISSN":["0011-9059","1365-4632"],"issn-type":[{"value":"0011-9059","type":"print"},{"value":"1365-4632","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,18]]},"assertion":[{"value":"2026-01-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ijd.70591"}}