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INDICATIONS FOR TESTING Suspected syphilis: Classic lesions present Suggestive STI history Current STI Consider retesting in 3- 12 months if patient remains in risk category © 2006 ARUP Laboratories. All Rights Reserved. Revised 01/14/2013 www.arupconsult.com Syphilis likely; stage disease using: Sexual history Syphilis treatment history Physical exam Syphilis (Reverse Sequence) Testing Click here for topics associated with this algorithm Primary stage: Oral chancre Genital chancre OR Secondary stage: Rash Condyloma lata Early latent: Asymptomatic Negative test <1 year ago Unknown latent: Asymptomatic No previous testing Late latent: Asymptomatic Duration >1 year Treat according to CDC guidelines REPEAT TITERS Rapid Plasma Reagin (RPR) with Reflex to Titer OR Treponema pallidum (VDRL), Serum with Reflex to Titer Cure Treatment failure or re-infection; follow recommended guidelines Yes No 4-fold decline in titers at 12 months PERFORM TREPONEMAL TESTING CIA/EIA Positive Negative CONFIRM WITH NONTREPONEMAL TESTING Rapid Plasma Reagin (RPR) with Reflex to Titer ORDER Treponema pallidum Antibody by TP-PA Syphilis unlikely Reactive Nonreactive Rreactive Nonreactive

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  • INDICATIONS FOR TESTINGSuspected syphilis:

    Classic lesions presentSuggestive STI historyCurrent STI

    Consider retesting in 3-12 months if patient remains in risk category

    2006 ARUP Laboratories. All Rights Reserved. Revised 01/14/2013 www.arupconsult.com

    Syphilis likely; stage disease using:

    Sexual historySyphilis treatment historyPhysical exam

    Syphilis (Reverse Sequence) TestingClick here for topics associated with this algorithm

    Primary stage:Oral chancre Genital chancre

    ORSecondary stage:

    RashCondyloma lata

    Early latent:AsymptomaticNegative test 1 year

    Treat according to CDC guidelines

    REPEAT TITERSRapid Plasma Reagin (RPR) with Reflex to Titer

    ORTreponema pallidum (VDRL), Serum with Reflex to Titer

    Cure Treatment failure or re-infection; follow recommended guidelines

    Yes No

    4-fold decline in titers at 12 months

    PERFORM TREPONEMAL TESTINGCIA/EIA

    Positive

    Negative

    CONFIRM WITH NONTREPONEMAL TESTINGRapid Plasma Reagin (RPR) with Reflex to Titer

    ORDERTreponema pallidumAntibody by TP-PA

    Syphilis unlikely

    Reactive

    NonreactiveRreactive

    Nonreactive

    Page-1


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