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Syphilis: Treponemal Antibodies With Reflex to RPR and RPR Titer, Reverse Screening and Diagnosis Algorithm |
Reflex to qualitative rapid plasma reagin (RPR) on positives
1 - 4 days
Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary.
For more information, please view the literature below.
Improved Syphilis Reverse Screening Cascade: Earlier Detection With Fewer Ambiguous Results
Serum
1 mL
0.5 mL (Note: This volume does not allow for repeat testing.)
Red-top tube or gel-barrier tube
Room temperature
Room temperature Room temperature |
Room temperature Room temperature |
Temperature | Period |
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Room temperature | 14 days |
Refrigerated | 14 days |
Frozen | 14 days |
Freeze/thaw cycles | Stable x3 |
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Hemolysis; lipemia; gross bacterial contamination; plasma specimen
This test is intended to support screening and diagnosis of syphilis infections. This test aligns with the CDC-supported reverse serologic testing algorithm for syphilis using a combination of both treponemal and nontreponemal antibody tests. The reverse syphilis testing algorithm begins with a treponemal antibody assay. Positive samples reflex to RPR (nontreponemal). If the RPR is positive, RPR titer will be determined. If the RPR is negative, a second treponemal antibody assay will be performed to confirm the presence of treponemal antibodies. Interpretation of results obtained must take into account patient symptoms and clinical history.
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This test is intended to support screening and diagnosis of syphilis infections. This test aligns with the CDC-supported reverse serologic testing algorithm for syphilis using a combination of both treponemal and nontreponemal antibody tests. The reverse syphilis testing algorithm begins with a treponemal antibody assay. Positive samples reflex to RPR (nontreponemal). If the RPR is positive, RPR titer will be determined. If the RPR is negative, a second treponemal antibody assay will be performed to confirm the presence of treponemal antibodies. Interpretation of results obtained must take into account patient symptoms and clinical history. |
Treponemal antibodies typically persist for life despite treatment; thus, this assay cannot be used to monitor reponse to treatment or to assess treatment outcomes. False positive treponemal antibody results have been observed in individuals with nonsyphilis treponemal infections (bejel, pinta, yaws).
T |
Treponemal antibodies typically persist for life despite treatment; thus, this assay cannot be used to monitor reponse to treatment or to assess treatment outcomes. False positive treponemal antibody results have been observed in individuals with nonsyphilis treponemal infections (bejel, pinta, yaws). |
Enzyme immunoassay (EIA) with reflex to charcoal flocculation if reactive
Treponemal antibody (CIA) | RPR | RPR titer | Treponemal antibody (EIA) | Interpretation |
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Nonreactive | Not done | Not done | Not done | No laboratory evidence of syphilis. If recent exposure is suspected, submit a new sample for testing in 2-4 weeks. |
Reactive | Nonreactive | Not done | Nonreactive | Treponemal antibodies not confirmed. Inconclusive for syphilis; potential early syphilis, possible false positive. If recent exposure is suspected, submit a new sample for testing in 2-4 weeks. If clinical suspicion is low no further evaluation is necessary. |
Reactive | Nonreactive | Not done | Reactive | Treponemal antibodies detected. Consistent with past or current (potential early) syphilis. Clinical evaluation should be performed to identify current signs and symptoms or past history of infection. If past history of treatment reported, no further management is needed unless symptomatic or recent exposure suspected. If no symptoms or past history of treatment, and if recent exposure is suspected, submit a new sample for testing in 2-4 weeks. |
Reactive | Reactive | 1:1 or greater | Not done | Treponemal and nontreponemal antibodies detected. Consisted with current or pasy syphilis. Clinical evaluation should be performed to identify current signs and symptoms or past history of infection. |
Association of Public Health Laboratories Ballard R. Changing Times in Syphilis Serology. Atlanta, Ga: Centers for Disease Control and Prevention, Association of Public Health Laboratories, Laboratory Learning Links Teleconference Series, 2008. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2008. Atlanta, Ga: CDC, November 2009. Cox DL. Letter to Phoenix Biotech, April 21, 2006. Cited with permission. Dang Q, Feng J, Lu X, et al. Evaluation of specific antibodies for early diagnosis and management of syphilis. Int J Dermatol. 2006 Oct; 45(10):1169-1171.17040431 Knight CS, Crum MA, Hardy RW. Evaluation of the LIAISON chemiluminescence immunoassay for diagnosis of syphilis. Clin Vaccine Immunol. 2007 Jun; 14(6):710-713.17460119 Lehnus & Associates Consulting. K053570-Response 1 for TREP-SURE Treponemal Antibody EIA. [letter] East Stroudsburg, Pa: Lehnus, May 4, 2006. Miranda APF, Sato NS. Profile of anti-Tp47 antibodies in patients with positive serology for syphilis analyzed by Western blot. Braz J Infect Dis. 2008 Apr; 12(2):139-143.18641851 Sambri V, Marangoni A, Eyer C, et al. Western immunoblotting with five Treponema pallidum recombinant antigens for serologic diagnosis of syphilis. Clin Diagn Lab Immunol. 2001 May; 8(3):534-539.11329453 Singh AE, Wong T, De P. Characteristics of primary and late latent syphilis cases which were initially nonreactive with the rapid plasma reagin as screening test. Int J STD AIDS. 2008 Jul; 19(7)464-468.18574118 Sloma CR, Stier TJ, Majewski DW, et al. Comparative evaluation of Capture®-S and TREP-SURE™ assays for serologic detection of syphilis in blood donors, May 11, 2007, abstract N° 07-AB-407-AABB. Stanford Hospital and Clinics, Stanford Medical Center. New ELISA screening for syphilis . . . flipping the treponemal paradigm. Lab Letter. 2007 Nov-Dec; 3(4):1-2. Tramont EC. Treponema pallidum (Syphilis). In: Mandell GL, Douglas RG Jr, Bennett JE, eds. Principles and Practice of Infectious Diseases. 2nd ed. Hoboken, NJ: John Wiley & Sons;1985. TREP-SURE™, Anti-Treponema EIA Screen. [Package insert] Mississauga, Ontario, Canada: Phoenix Bio-Tech; 2010. US Preventive Services Task Force. Screening for syphilis infection in pregnancy: US Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2009 May 19; 150(10)705-709.19451577 |
Association of Public Health Laboratories (APHL). Suggested Reporting Language for Syphilis Serological Testing, 2nd ed. August 2020. Accessed via APHL website at https://www.aphl.org/programs/infectious_disease/std/Pages/Syphilis.aspx. Workowski KA, Bachman LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.34292926 |
Order Code | Order Code Name | Order Loinc | Result Code | Result Code Name | UofM | Result LOINC |
---|---|---|---|---|---|---|
082345 | T pallidum Screening Cascade | 47236-5 | 082356 | T pallidum Antibodies | 47236-5 |
Reflex Table for T pallidum Antibodies | ||||||
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Order Code | Order Name | Result Code | Result Name | UofM | Result LOINC | |
Reflex 1 | 006099 | RPR | 006097 | RPR | 20507-0 | |
Reflex 2 | 006476 | RPR, Quant | 006476 | RPR, Quant | 31147-2 |
Reflex Table for T pallidum Antibodies | ||||||
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Order Code | Order Name | Result Code | Result Name | UofM | Result LOINC | |
Reflex 1 | 006099 | RPR | 006097 | RPR | 20507-0 | |
Reflex 2 | 163038 | T pallidum Antibody, EIA | 163038 | T pallidum Antibody, EIA | 34147-9 |
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