biostudies-literatureUnknown12(9)Hughes Y<h4>Background</h4>Earlier syphilis detection is needed to reduce infectiousness and transmission and to improve control. Polymerase chain reaction (PCR) for <i>Treponema pallidum</i> is highly sensitive for detecting primary syphilis but is not often widely available or used. The aim of this systematic review and meta-analysis was to investigate the proportion of PCR-positive, seronegative primary syphilis infections when serology was performed at clinical presentation.<h4>Methods</h4>We undertook a systematic review and meta-analysis to identify studies of patients presenting with primary syphilis where <i>T pallidum</i> PCR was performed on the primary syphilis lesion and serology for syphilis was performed on the same occasion. The review was conducted according to the Cochrane protocoOpen forum infectious diseasesofaf471https://www.ebi.ac.uk/biostudies/studies/S-EPMC12461845biostudies-literatureThe Proportion of &lt;i&gt;Treponema pallidum&lt;/i&gt; Polymerase Chain Reaction-Positive Primary Syphilis Infections That Are Seronegative for Syphilis: A Systematic Review and Meta-analysis.PMC12461845Azzato FOng JJChow EPFChen MYWilliams EBilardi JPasricha SFairley CKTowns JMHocking JSHughes YWilliamson DAfalseThe Proportion of &lt;i&gt;Treponema pallidum&lt;/i&gt; Polymerase Chain Reaction-Positive Primary Syphilis Infections That Are Seronegative for Syphilis: A Systematic Review and Meta-analysis.<h4>Background</h4>Earlier syphilis detection is needed to reduce infectiousness and transmission and to improve control. Polymerase chain reaction (PCR) for <i>Treponema pallidum</i> is highly sensitive for detecting primary syphilis but is not often widely available or used. The aim of this systematic review and meta-analysis was to investigate the proportion of PCR-positive, seronegative primary syphilis infections when serology was performed at clinical presentation.<h4>Methods</h4>We undertook a systematic review and meta-analysis to identify studies of patients presenting with primary syphilis where <i>T pallidum</i> PCR was performed on the primary syphilis lesion and serology for syphilis was performed on the same occasion. The review was conducted according to the Cochrane protoco2025-01-01T00:00:00Z2025 Sep2026-05-02T03:16:06.449Z2026-05-02T03:08:09.709ZS-EPMC124618454101869810.1093/ofid/ofaf471