Syphilis laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Laboratory Findings

• Darkfield examinations and tests to detect T. pallidum in lesion exudate or tissue are the definitive methods for diagnosing early syphilis.

• Although no T. pallidum detection tests are commercially available, some laboratories provide locally developed PCR tests for the detection of T. pallidum.

• A presumptive diagnosis of syphilis is possible with the use of two types of serologic tests:

• Nontreponemal tests (e.g., venereal disease research laboratory (VDRL) and rapid plasma reagent test) and
• Treponemal tests (e.g., fluorescent treponemal antibody absorbed (FTA-ABS) tests, the T. pallidum passive particle agglutination (TP-PA) assay, various enzyme immunoassays, and chemiluminescence immunoassays).

• The use of only one type of serologic test is insufficient for diagnosis, because each type of test has limitations, including the possibility of false-positive test results in persons without syphilis.

• False-positive nontreponemal test results can be associated with various medical conditions unrelated to syphilis, including autoimmune conditions, older age, and injection-drug use; therefore, persons with a reactive nontreponemal test should receive a treponemal test to confirm the diagnosis of syphilis.

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