Has Your Lab Changed Its Syphilis Testing Protocol?

For decades, syphilis testing meant first screening a patient with a nontreponemal test, such as the rapid plasma reagin (RPR) test, which identifies recent or untreated syphilis but can yield false-positive results. Reactive specimens then were retested with specific treponemal tests, such as the fluorescent treponemal antibody (FTA-ABS) test, which confirm syphilis but which always will be positive after initial infection — even when treatment is successful. Now financial considerations have turned this old algorithm on its head, much to everyone’s confusion.

CDC researchers examined testing protocols in four New York City laboratories that perform initial syphilis screening with specific treponemal enzyme immunoassay (EIA) tests, which ar…