{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T08:34:07Z","timestamp":1775032447429,"version":"3.50.1"},"reference-count":71,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:p>\n                    The global resurgence of syphilis, characterized by a precipitous rise in incidence and the persistence of congenital transmission, has necessitated a critical re-evaluation of traditional diagnostic paradigms. This review synthesizes recent technological innovations in the detection of\n                    <jats:italic>Treponema pallidum<\/jats:italic>\n                    , spanning from molecular precision to decentralized point-of-care (POC) accessibility. This review synthesizes the paradigm shift from traditional darkfield microscopy (DFM) toward advanced nucleic acid amplification tests (NAATs). By evaluating innovations such as CRISPR-based assays and transcription-mediated amplification (TMA), we highlight their capacity to bridge the diagnostic \u2018window period\u2019 where traditional serology often fails. Furthermore, the review evaluates the clinical adaptability of automated reverse-sequence algorithms and the utilization of signal-to-cutoff (S\/Co) ratios to optimize high-throughput laboratory workflows. Significant attention is given to breakthroughs in biosensing\u2014such as silk cocoon membrane-integrated platforms\u2014and the role of novel biomarkers like IgA and proteomic arrays in differentiating active infection from historical exposure. The significance of this review lies in its comprehensive mapping of \u201cbreakthrough pathways\u201d that address diagnostic bottlenecks in complex manifestations like neurosyphilis and neonatal cases. Evidence suggests that while these technological breakthroughs possess transformative potential, their global scalability remains constrained by a dual challenge: the lack of standardized commercial platforms and the diagnostic ambiguity posed by the \u2018serofast\u2019 state. Consequently, the integration of these innovations into routine practice requires moving beyond isolated tools toward a cohesive, multimodal diagnostic framework Future perspectives emphasize the integration of smartphone-based AI diagnostics and the necessity of aligning technological advancements with biomedical prevention strategies, such as DoxyPEP and multi-epitope vaccine development. Ultimately, establishing a multi-modal diagnostic ecosystem that prioritizes health equity and real-time surveillance is essential for dismantling the systemic barriers to global syphilis elimination.\n                  <\/jats:p>","DOI":"10.3389\/fcimb.2026.1781460","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T05:41:25Z","timestamp":1775022085000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Technological innovations and breakthrough pathways in syphilis diagnosis: addressing global resurgence and the journey toward elimination"],"prefix":"10.3389","volume":"16","author":[{"given":"Juan","family":"Hu","sequence":"first","affiliation":[{"name":"Department of Clinical Laboratory, Suining Central Hospital","place":["Suining, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunyan","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Suining Central Hospital","place":["Suining, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Suining Central Hospital","place":["Suining, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanting","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Suining Central Hospital","place":["Suining, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guangjun","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Suining Central Hospital","place":["Suining, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1111\/1751-7915.70153","article-title":"Loop\u2010mediated isothermal amplification (LAMP) for the diagnosis of sexually transmitted infections: A review","volume":"18","author":"Ahmadi","year":"2025","journal-title":"Microb. Biotechnol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1136\/sextrans-2023-055913","article-title":"Multicentric evaluation of a specific intrathecal anti- Treponema pallidum IgG index as a diagnostic biomarker of neurosyphilis: Results from a retro-prospective case\u2013control study","volume":"100","author":"Alberto","year":"2024","journal-title":"Sex Transm. Infect"},{"key":"B58","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1097\/QCO.0000000000000895","article-title":"Shifting the power: scale-up of access to point-of-care and self-testing for sexually transmitted infections in low-income and middle-income settings","volume":"36","author":"Arrigo","year":"2023","journal-title":"Curr. Opin. Infect. Dis"},{"key":"B10","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1097\/olq.0000000000002094","article-title":"Congenital syphilis in the US: A narrative review","volume":"52","author":"Azqul","year":"2025","journal-title":"Sex Transm. Dis"},{"key":"B62","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics13121183","article-title":"From cure to prevention: Doxycycline\u2019s potential in prophylaxis for sexually transmitted infections","volume":"13","author":"Bird","year":"2024","journal-title":"Antibiotics"},{"key":"B59","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.01234-25","article-title":"Clinical evaluation of a novel multiplex point-of-care test for the dual detection of HIV and syphilis antibodies","volume":"63","author":"Bristow","year":"2025","journal-title":"J. Clin. Microbiol"},{"key":"B68","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0273713","article-title":"Stopping syphilis transmission in Arctic communities through rapid diagnostic testing: The STAR study protocol","volume":"17","author":"Caya","year":"2022","journal-title":"PloS One"},{"key":"B20","doi-asserted-by":"publisher","first-page":"4671","DOI":"10.1038\/s41467-022-32250-y","article-title":"A suite of PCR-LwCas13a assays for detection and genotyping of Treponema pallidum in clinical samples","volume":"13","author":"Chen","year":"2022","journal-title":"Nat. Commun"},{"key":"B14","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1186\/s40249-024-01231-2","article-title":"Global patterns of syphilis, gonococcal infection, typhoid fever, paratyphoid fever, diphtheria, pertussis, tetanus, and leprosy from 1990 to 2021: Findings from the Global Burden of Disease Study 2021","volume":"13","author":"Chen","year":"2024","journal-title":"Infect. Dis. Poverty"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.00476-24","article-title":"Improved efficiency using sequential automated immunoassays for syphilis screening in blood donors","volume":"62","author":"Cheng","year":"2024","journal-title":"J. Clin. Microbiol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e11","DOI":"10.1097\/olq.0000000000001848","article-title":"Sexually transmitted infection point-of-care testing in resource-limited settings: A narrative review guided by an implementation framework","volume":"50","author":"Chitneni","year":"2023","journal-title":"Sex Transm. Dis"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.1101\/2025.01.07.25320135","article-title":"Clinical development and performance of the First to Know Syphilis Self-Test for over-the-counter usage: a de novo rapid test for treponemal antibody","volume":"63","author":"Clark","year":"2025","journal-title":"J. Clin. Microbiol"},{"key":"B60","doi-asserted-by":"publisher","first-page":"381","DOI":"10.5694\/mja2.52258","article-title":"Australian consensus statement on doxycycline post\u2010exposure prophylaxis (doxy\u2010PEP) for the prevention of syphilis, chlamydia and gonorrhoea among gay, bisexual and other men who have sex with men","volume":"220","author":"Cornelisse","year":"2024","journal-title":"Med. J. Aust"},{"key":"B22","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1097\/olq.0000000000001621","article-title":"Correlation of treponemal chemiluminescent microparticle immunoassay screening test signal strength values with reactivity of confirmatory testing","volume":"49","author":"Demir \u00c7uha","year":"2022","journal-title":"Sex Transm. Dis"},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.00094-25","article-title":"A novel colorimetric immunosensor based on silk cocoon membrane-integrated ELISA for treponemal antibody detection","volume":"13","author":"Duan","year":"2025","journal-title":"Microbiol. Spectr"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e612","DOI":"10.2139\/ssrn.5381800","article-title":"Global, regional, and national burden of syphilis 1990\u20132021: A systematic analysis for the global burden of disease study 2021","volume":"12","year":"2024","journal-title":"Lancet Glob. Health"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e1544","DOI":"10.1016\/s2214-109x(24)00266-3","article-title":"WHO global research priorities for sexually transmitted infections","volume":"12","author":"Gottlieb","year":"2024","journal-title":"Lancet Glob. Health"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.15620\/cdc:145590","article-title":"Trends and characteristics in maternal syphilis rates during pregnancy: United States, 2016\u20132022","author":"Gregory","year":"2024"},{"key":"B30","first-page":"169","article-title":"A microflocculation test for syphilis using cardiolipin antigen; preliminary report","volume":"27","author":"Harris","year":"1946","journal-title":"J. Vener. Dis. Inf"},{"key":"B43","first-page":"1039","article-title":"Detection of treponema pallidum in joint fluid by the polymerase chain reaction","volume":"49","author":"Hay","year":"1990","journal-title":"Ann. Rheumatol. Dis"},{"key":"B24","doi-asserted-by":"publisher","first-page":"e0346623","DOI":"10.1128\/spectrum.03466-23","article-title":"Evaluation of a minimal array of Treponema pallidum antigens as biomarkers for syphilis diagnosis, infection staging, and response to treatment","volume":"12","author":"Haynes","year":"2023","journal-title":"Microbiol. Spectr"},{"key":"B64","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1130593","article-title":"Immunization with Tp0954, an adhesin of treponema pallidum, provides protective efficacy in the rabbit model of experimental syphilis","volume":"14","author":"He","year":"2023","journal-title":"Front. Immunol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1002\/mdr2.70039","article-title":"RSA-KG: A Graph-Based rag enhanced AI knowledge graph for recurrent spontaneous abortions diagnosis and clinical decision support","volume":"13","author":"He","year":"2025","journal-title":"Med. Res. Arch"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1550","DOI":"10.1016\/b978-1-4377-1604-7.00327-4","article-title":"Syphilis","volume":"389","author":"Hook","year":"2017","journal-title":"Lancet"},{"key":"B28","doi-asserted-by":"publisher","first-page":"ofaf471","DOI":"10.1891\/9780826153425.0015e","article-title":"The proportion of Treponema pallidum polymerase chain reaction\u2013positive primary syphilis infections that are seronegative for syphilis: A systematic review and meta-analysis","volume":"12","author":"Hughes","year":"2025","journal-title":"Open Forum Infect. Dis"},{"key":"B36","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1111\/jdv.16946","article-title":"2020 European guideline on the management of syphilis","volume":"35","author":"Janier","year":"2021","journal-title":"J. Eur. Acad. Dermatol. Venereol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.rr7301a1","article-title":"CDC laboratory recommendations for syphilis testing, United States, 2024","volume":"73","author":"Papp","year":"2024","journal-title":"Morb. Mortal. Wkly. Rep"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1034","DOI":"10.1001\/archinte.1993.00410210124014","article-title":"Prozone phenomenon in serologic tests for syphilis","volume":"276","author":"Jurado","year":"1996","journal-title":"JAMA"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1080\/22221751.2024.2348525","article-title":"Evaluating the clinical utility of semi-quantitative luciferase immunosorbent assay using Treponema pallidum antigens in syphilis diagnosis and treatment monitoring","volume":"13","author":"Ke","year":"2024","journal-title":"Emerg. Microbes Infect"},{"key":"B12","doi-asserted-by":"publisher","first-page":"661","DOI":"10.15585\/mmwr.mm6922a1","article-title":"Missed opportunities for prevention of congenital syphilis \u2014 United States, 2018","volume":"69","author":"Kimball","year":"2020","journal-title":"MMWR Morb. Mortal. Wkly. Rep"},{"key":"B37","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1177\/0956462415624059","article-title":"UK national guideline on the management of syphilis 2015","volume":"27","author":"Kingston","year":"2016","journal-title":"Int. J. STD AIDS"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0298288","article-title":"Rapid resurgence of syphilis in Japan after the COVID-19 pandemic: A descriptive study","volume":"19","author":"Komori","year":"2024","journal-title":"PloS One"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.00388-25","article-title":"Advanced specificity and sensitivity studies relative to a research use only transcription-mediated amplification-based assay for Treponema pallidum RNA detection","volume":"63","author":"Krueger","year":"2025","journal-title":"J. Clin. Microbiol"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1002\/smsc.202500046","article-title":"Treponema pallidum protein Tp0136 induces spheroidization of vascular endothelial cells, resulting in widened intercellular junctions and enhanced vascular permeability","volume":"5","author":"Lin","year":"2025","journal-title":"Small Sci"},{"key":"B63","doi-asserted-by":"publisher","DOI":"10.1097\/olq.0000000000002050","article-title":"New pathways in syphilis vaccine development","volume":"51","author":"Liu","year":"2024","journal-title":"Sex Transm. Dis"},{"key":"B47","first-page":"512","article-title":"Field-deployable CRISPR-cas assays for ultrasensitive detection of treponema pallidum","volume":"30","author":"Lu","year":"2024","journal-title":"Nat. Med"},{"key":"B46","article-title":"Performance of transcription-mediated amplification for detecting treponema pallidum in mucosal swabs from high-risk groups","volume":"61","author":"Lutz","year":"2023","journal-title":"J. Clin. Microbiol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofaf472","article-title":"Intersecting risk factors associated with high syphilis seroprevalence among a street-involved population in Canada","volume":"12","author":"Mackrell","year":"2025","journal-title":"Open Forum Infect. Dis"},{"key":"B41","doi-asserted-by":"publisher","first-page":"S251","DOI":"10.1016\/j.ajog.2023.11.406","article-title":"380 cost-effectiveness of a reverse screening algorithm for syphilis in pregnancy","volume":"230","author":"Megha","year":"2024","journal-title":"Am. J. Obstet. Gynecol"},{"key":"B61","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1016\/s1473-3099(17)30725-9","article-title":"Post-exposure prophylaxis with doxycycline to prevent sexually transmitted infections in men who have sex with men (IPERGAY): An open-label randomised substudy","volume":"18","author":"Molina","year":"2018","journal-title":"Lancet Infect. Dis"},{"key":"B35","first-page":"261","article-title":"Current trends in syphilis diagnosis: Traditional and reverse algorithms","volume":"21","author":"Morshed","year":"2014","journal-title":"Clin. Vaccine Immunol"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.00686-22","article-title":"British Columbia\u2019s experience after implementation of the Treponema pallidum reverse algorithm and PCR detection, 2015 to 2020","volume":"10","author":"Morshed","year":"2022","journal-title":"Microbiol. Spectr"},{"key":"B5","unstructured":"New report flags major increase in sexually transmitted infections, amidst challenges in HIV and hepatitis"},{"key":"B71","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-093330","article-title":"Diagnostic performance of the Hightop Rapid Diagnostic Test for the detection of anti- Treponema pallidum antibodies in Cameroon: a laboratory-based cross-sectional and comparative study","volume":"15","author":"Taheu Ngounouh","year":"2025","journal-title":"BMJ Open"},{"key":"B69","doi-asserted-by":"publisher","DOI":"10.1016\/s2214-109x(23)00405-9","article-title":"Maternal and congenital syphilis attributable to ethnoracial inequalities: a national record-linkage longitudinal study of 15 million births in Brazil","volume":"11","author":"Paixao","year":"2023","journal-title":"Lancet Glob. Health"},{"key":"B39","first-page":"456","article-title":"Optimization of signal-to-cutoff ratios in automated treponemal immunoassays for the diagnosis of syphilis","volume":"43","author":"Park","year":"2023","journal-title":"Ann. Lab. Med"},{"key":"B70","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1038\/nrmicro911","article-title":"Syphilis","volume":"9","author":"Peeling","year":"2023","journal-title":"Nat. Rev. Dis. Primer"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19138172","article-title":"Point-of-care diagnostics for diagnosis of active syphilis infection: Needs, challenges and the way forward","volume":"19","author":"Pham","year":"2022","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1603.e1","DOI":"10.1016\/j.cmi.2023.08.015","article-title":"Anti-Treponema pallidum IgA response as a potential diagnostic marker of syphilis","volume":"29","author":"Rodr\u00edguez","year":"2023","journal-title":"Clin. Microbiol. Infect"},{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14155308","article-title":"The epidemiology of syphilis worldwide in the last decade","volume":"14","author":"Rosset","year":"2025","journal-title":"J. Clin. Med"},{"key":"B33","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1097\/aog.0000000000006019","article-title":"Cost effectiveness of the reverse sequence algorithm compared with the traditional algorithm for syphilis screening among pregnant women","volume":"146","author":"Saldarriaga","year":"2025","journal-title":"Obstet. Gynecol"},{"key":"B66","doi-asserted-by":"publisher","first-page":"100871","DOI":"10.1016\/s2666-5247(24)00087-9","article-title":"Clinical and genomic diversity of Treponema pallidum subspecies pallidum to inform vaccine research: an international, molecular epidemiology study","volume":"5","author":"Se\u00f1a","year":"2024","journal-title":"Lancet Microbe"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2024.1348437","article-title":"Evaluating the diagnostic accuracy of TpN17 and TmpA recombinant proteins in syphilis detection: A phase II study","volume":"15","author":"Silva","year":"2024","journal-title":"Front. Microbiol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1097\/olq.0000000000001633","article-title":"Performance of molecular tests in the diagnosis of syphilis from 2009 to 2019: A systematic review and meta-analysis","volume":"49","author":"Simpore","year":"2022","journal-title":"Sex Transm. Dis"},{"key":"B29","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1097\/qco.0000000000001073","article-title":"Update on syphilis diagnostics","volume":"38","author":"Sweitzer","year":"2025","journal-title":"Curr. Opin. Infect. Dis"},{"key":"B65","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1097\/qco.0000000000000875","article-title":"New trends in congenital syphilis: epidemiology, testing in pregnancy, and management","volume":"35","author":"Thean","year":"2022","journal-title":"Curr. Opin. Infect. Dis"},{"key":"B72","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-055275","article-title":"Standardised protocol for a prospective cross-sectional multicentre clinical utility evaluation of two dual point-of-care tests in non-clinical settings for the screening of HIV and syphilis in men who have sex with men","volume":"12","year":"2022","journal-title":"BMJ Open"},{"key":"B42","doi-asserted-by":"publisher","first-page":"e26","DOI":"10.1097\/olq.0000000000001955","article-title":"Estimating the proportion of people living with HIV who may benefit from the reverse algorithm for the diagnosis of incident syphilis","volume":"51","author":"Menza","year":"2024","journal-title":"Sex Transm. Dis"},{"key":"B17","doi-asserted-by":"publisher","first-page":"935","DOI":"10.1093\/clinchem\/hvaf072","article-title":"Advances in syphilis diagnostics to address the 21st-century epidemic","volume":"71","author":"Treger","year":"2025","journal-title":"Clin. Chem"},{"key":"B56","doi-asserted-by":"publisher","first-page":"e0264221","DOI":"10.1128\/spectrum.02642-21","article-title":"Laboratory evaluation of the DPP syphilis screen & Confirm assay","volume":"10","author":"Vargas","year":"2022","journal-title":"Microbiol. Spectr"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.1001\/jama.2025.0171","article-title":"Point-of-care testing to combat congenital syphilis\u2014the time is now","volume":"333","author":"Wall","year":"2025","journal-title":"JAMA"},{"key":"B67","doi-asserted-by":"publisher","first-page":"2399915","DOI":"10.1080\/21645515.2024.2399915","article-title":"Syphilis vaccine development: Aligning vaccine design with manufacturing requirements","volume":"20","author":"Waugh","year":"2024","journal-title":"Hum. Vaccines Immunother"},{"key":"B4","article-title":"Global report on HIV, viral hepatitis and sexually transmitted infections 2024: Accountability for the global health sector strategies 2022\u20132030","year":"2024","journal-title":"World Health Organ"},{"key":"B40","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.rr7004a1","article-title":"Sexually transmitted infections treatment guidelines, 2021","volume":"70","author":"Niforatos","year":"2021","journal-title":"MMWR Recomm. Rep"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1105847","article-title":"Performance of the nontreponemal tests and treponemal tests on cerebrospinal fluid for the diagnosis of neurosyphilis: A meta-analysis","volume":"11","author":"Xie","year":"2023","journal-title":"Front. Public Health"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1111","DOI":"10.1038\/s41598-025-97155-4","article-title":"A streamlined POCT solution for rapid infectious disease detection","volume":"15","author":"Xie","year":"2025","journal-title":"Dent. Sci. Rep"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.14.04004","article-title":"Syphilis epidemic among men who have sex with men: A global systematic review and meta-analysis of prevalence, incidence, and associated factors","volume":"14","author":"Zheng","year":"2024","journal-title":"J. Glob. Health"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2022.985373","article-title":"Neurosyphilis with ocular involvement and normal magnetic resonance imaging results affirmed by metagenomic next-generation sequencing","volume":"12","author":"Zhou","year":"2022","journal-title":"Front. Cell. Infect. Microbiol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopha.2024.117478","article-title":"Potential mechanisms of Treponema pallidum breaching the blood-brain barrier","volume":"180","author":"Zhou","year":"2024","journal-title":"Biomed. Pharmacother"},{"key":"B44","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1093\/cid\/ciad455","article-title":"Timely diagnosis of incubating syphilis infections using Treponema pallidum transcription-mediated amplification assay","volume":"77","author":"Zondag","year":"2023","journal-title":"Clin. Infect. Dis"},{"key":"B38","doi-asserted-by":"publisher","first-page":"e0303253","DOI":"10.1371\/journal.pone.0303253","article-title":"Single-test syphilis serology: A case of not seeing the forest for the trees","volume":"19","author":"Zulu","year":"2024","journal-title":"PloS One"}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1781460\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T05:41:29Z","timestamp":1775022089000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1781460\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":71,"alternative-id":["10.3389\/fcimb.2026.1781460"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2026.1781460","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]},"article-number":"1781460"}}