Materiały źródłowe

• #1

  https://www.who.int/news-room/fact-sheets/detail/syphilis

  Syphilis diagnosis is based on the persons clinical and sexual history, physical examination, laboratory testing and sometimes radiology, as symptoms are not common or noticeable. […] Laboratory tests for syphilis include direct detection of T. pallidum through a microscope or indirect methods such as blood tests. Rapid tests are also available and can provide results in minutes, facilitating immediate treatment initiation. […] Identifying asymptomatic infection through laboratory or rapid tests and providing adequate treatment of positive cases will prevent further transmission and complications, as well as adverse pregnancy outcomes, including congenital syphilis. […] There are currently no diagnostic tests for congenital syphilis. All live or stillborn infants of women with syphilis should be examined for evidence of congenital syphilis. For live-born infants, clinical examination, radiology (if available) and laboratory tests at birth and follow up tests will help to define treatment.

• #2 Diagnosis and Management of Syphilis | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0715/p283.html

  Syphilis is a sexually transmitted disease with varied and often subtle clinical manifestations. […] The diagnosis of syphilis may involve dark-field microscopy of skin lesions but most often requires screening with a nontreponemal test and confirmation with a treponemal-specific test. […] Primary syphilis is diagnosed by dark-field microscopy of a suspected lesion or by serologic testing. […] The diagnosis of secondary syphilis is confirmed by nontreponemal and treponemal-specific tests. […] Lumbar puncture is required to establish the diagnosis of neurosyphilis. […] Treponemal-specific testing (e.g., TPHA) is helpful only when the result is negative (i.e., it rules out neurosyphilis). […] Neurosyphilis should be considered in patients with signs or symptoms of neurologic involvement at any stage of T. pallidum infection and in all patients with late latent or tertiary syphilis, although asymptomatic neurosyphilis is the most common presentation.

• #3 Diagnostic tests for syphilis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4999316/

  Syphilis is a sexually transmitted infection caused by Treponema pallidum. The disease is mainly diagnosed through clinical findings and serologic testing. However, no single serologic test of syphilis is sufficient. Hence, the serologic diagnosis of syphilis requires the detection of 2 types of antibodies (nontreponemal antibodies and treponemal antibodies). […] The diagnosis is mainly based on clinical findings and serologic tests since the organism cannot be grown in vitro. Confirmation of the diagnosis is through serologic testing. As no single test is able to diagnose active syphilis, a combination of treponemal and nontreponemal tests is used. […] Although these methods are not widely available, there are several tests that can be used to directly detect the organism. These include dark-field microscopy, PCR, and direct fluorescent antibody testing for T pallidum.

• #4 Syphilis: Screening and diagnostic testing – UpToDate

  https://www.uptodate.com/contents/syphilis-screening-and-diagnostic-testing

  Treponemal tests have historically been more complex and expensive to perform than nontreponemal tests. Thus, they have traditionally been used as confirmatory tests for syphilis when the nontreponemal tests are reactive. […] A rapid definitive diagnosis of syphilis was previously made using darkfield microscopy to examine exudates of lesions for the presence of Treponema pallidum organisms. This method, which is complex, is no longer routinely available in most clinics. […] Direct methods can be used to provide a definitive diagnosis of syphilis. Since Treponema pallidum cannot be cultured in the laboratory, the organism must be identified through direct visualization or detection in clinical specimens. […] Serologic testing algorithms to diagnose syphilis should include the use of both nontreponemal and treponemal tests. Confirmatory testing is necessary due to the potential for a false-positive screening test result.

• #5 Diagnostic tests for syphilis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4999316/

  Syphilis is a sexually transmitted infection caused by Treponema pallidum. The disease is mainly diagnosed through clinical findings and serologic testing. However, no single serologic test of syphilis is sufficient. Hence, the serologic diagnosis of syphilis requires the detection of 2 types of antibodies (nontreponemal antibodies and treponemal antibodies). […] The diagnosis is mainly based on clinical findings and serologic tests since the organism cannot be grown in vitro. Confirmation of the diagnosis is through serologic testing. As no single test is able to diagnose active syphilis, a combination of treponemal and nontreponemal tests is used. […] Although these methods are not widely available, there are several tests that can be used to directly detect the organism. These include dark-field microscopy, PCR, and direct fluorescent antibody testing for T pallidum.

• #6 Syphilis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/syphilis.htm

  Bicillin L-A is the first-line recommended treatment for syphilis and the only recommended treatment option for some patients. […] Darkfield examinations and molecular tests for detecting T. pallidum directly from lesion exudate or tissue are the definitive methods for diagnosing early syphilis and congenital syphilis. […] A presumptive diagnosis of syphilis requires use of two laboratory serologic tests: a nontreponemal test (i.e., Venereal Disease Research Laboratory [VDRL] or rapid plasma reagin [RPR] test) and a treponemal test (i.e., the T. pallidum passive particle agglutination [TP-PA] assay, various EIAs, chemiluminescence immunoassays [CIAs] and immunoblots, or rapid treponemal assays). […] Use of only one type of serologic test (nontreponemal or treponemal) is insufficient for diagnosis and can result in false-negative results among persons tested during primary syphilis and false-positive results among persons without syphilis or previously treated syphilis.

• #7 CDC Laboratory Recommendations for Syphilis Testing, United States, 2024 | MMWR

  https://www.cdc.gov/mmwr/volumes/73/rr/rr7301a1.htm

  Nontreponemal (lipoidal antigen) tests (e.g., RPR or VDRL) are not interchangeable when used to determine antibody titers; testing on follow-up samples must be performed with the same type of test. The Treponema pallidum particle agglutination test is the preferred manual treponemal test. […] Nontreponemal (lipoidal antigen) and treponemal tests should be interpreted in the same manner regardless of pregnancy status. […] Nontreponemal (lipoidal antigen) and treponemal tests should be interpreted in the same manner regardless of HIV status. […] Darkfield microscopy should be maintained if already in use or established in sexually transmitted diseases clinics where a point-of-care test for primary or secondary syphilis diagnosis would be beneficial for timely patient treatment. […] Immunohistochemistry is preferred over silver staining for formalin-fixed, paraffin-embedded tissue sections regardless of anatomic site.

• #8 Syphilis – Wikipedia

  https://en.wikipedia.org/wiki/Syphilis

  Syphilis is most commonly spread through sexual activity. […] Diagnosis is usually made by using blood tests; the bacteria can also be detected using dark field microscopy. […] Confirmation is either via blood tests or direct visual inspection using dark field microscopy. […] Blood tests are divided into nontreponemal and treponemal tests. […] Because of the possibility of false positives with nontreponemal tests, confirmation is required with a treponemal test, such as Treponema pallidum particle agglutination assay (TPHA) or fluorescent treponemal antibody absorption test (FTA-Abs). […] Neurosyphilis is diagnosed by finding high numbers of leukocytes (predominately lymphocytes) and high protein levels in the cerebrospinal fluid in the setting of a known syphilis infection. […] Dark field microscopy of serous fluid from a chancre may be used to make an immediate diagnosis. […] Two other tests can be carried out on a sample from the chancre: direct fluorescent antibody (DFA) and polymerase chain reaction (PCR) tests.

• #9 Syphilis: Symptoms, Causes, and Treatments > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/syphilis

  How is syphilis diagnosed? […] To diagnose syphilis, your doctor will review your medical history, conduct a physical exam, and order one or more diagnostic tests. […] There are several diagnostic tests that can be used to confirm a syphilis diagnosis: […] Blood tests. Two types of blood tests are required to diagnose syphilis. […] Direct fluorescent antibody (DFA) test. For this test, a fluorescent dye is added to the tissue sample. […] Cerebrospinal fluid (CSF) test. If the doctor suspects that syphilis has affected the nervous system, they may perform a spinal tap (or lumbar puncture) to collect a sample of CSF, the fluid that surrounds the brain and spinal cord, to check for possible antibodies or other evidence that syphilis could be affecting the central nervous system (CNS).

• #10 PCR swabs: a useful diagnostic tool for identifying syphilis | This Changed My Practice (TCMP) by UBC CPD

  https://thischangedmypractice.com/pcr-swabs-diagnostic-tool-identifying-syphilis/

  Primary and secondary syphilis can present in a variety of manners which makes diagnosing syphilis challenging. […] The BCCDC website includes resources that provide detailed resources for clinicians considering a diagnosis of syphilis. Staging of infections is based on laboratory results together with a thorough history and clinical assessment, and is done provincially by a specialized group of STI physicians for all reactive syphilis tests in BC. This process also determines if the reactive serology indicates active infection that requires treatment or a previous infection that requires no treatment. […] During this experience, I was introduced to another diagnostic tool for syphilis presentation: syphilis nucleic acid amplification by PCR (NAAT-PCR). Given that the screening EIA, the RPR, and the confirmatory TPPA tests usually become positive about 2 to 4 weeks after infection (but may take up to 90 days), there is a chance of false-negative serology during early infection. Therefore, direct detection tests such as a syphilis PCR swab that collects fluid from ulcerative lesions, or other infected tissues (e.g., rectal swab for proctitis symptoms) can enable earlier detection. A recent study was published by the BCCDC Public Health Laboratory assessing the diagnostic performance of PCR-based T. pallidum DNA detection from 2015-2020. The study found that this PCR-based syphilis testing exhibited excellent sensitivity (99.5%) and specificity (100%).

• #11 Syphilis Diagnosis and Treatment: State of the Art | EMJ Reviews

  https://www.emjreviews.com/dermatology/article/syphilis-diagnosis-and-treatment-state-of-the-art/

  Since T. pallidum cannot be grown in culture, the direct diagnosis is obtained by the detection with darkfield microscopy of the spirochaetes in fluid or smears procured from a lesion. […] The CDC initially approved darkfield microscopy and PCR as criteria for the direct detection of T. pallidum in tissue specimens. […] The histopathological features reported for the primary syphilis lesion are nonspecific and limited by the ulcerative nature of the lesion itself. […] Immunohistochemistry using a monoclonal antibody to T. pallidum can be performed on bioptic specimens. […] The indirect diagnosis of syphilis currently relies on serological tests for the detection of antibodies. […] Two types of serologic tests for syphilis, nontreponemal and treponema-specific tests, were largely validated for diagnostic confirmation of syphilitic infection.

• #12 CDC Laboratory Recommendations for Syphilis Testing, United States, 2024 | MMWR

  https://www.cdc.gov/mmwr/volumes/73/rr/rr7301a1.htm

  Nontreponemal (lipoidal antigen) tests (e.g., RPR or VDRL) are not interchangeable when used to determine antibody titers; testing on follow-up samples must be performed with the same type of test. The Treponema pallidum particle agglutination test is the preferred manual treponemal test. […] Nontreponemal (lipoidal antigen) and treponemal tests should be interpreted in the same manner regardless of pregnancy status. […] Nontreponemal (lipoidal antigen) and treponemal tests should be interpreted in the same manner regardless of HIV status. […] Darkfield microscopy should be maintained if already in use or established in sexually transmitted diseases clinics where a point-of-care test for primary or secondary syphilis diagnosis would be beneficial for timely patient treatment. […] Immunohistochemistry is preferred over silver staining for formalin-fixed, paraffin-embedded tissue sections regardless of anatomic site.

• #13 PCR swabs: a useful diagnostic tool for identifying syphilis | This Changed My Practice (TCMP) by UBC CPD

  https://thischangedmypractice.com/pcr-swabs-diagnostic-tool-identifying-syphilis/

  Primary and secondary syphilis can present in a variety of manners which makes diagnosing syphilis challenging. […] The BCCDC website includes resources that provide detailed resources for clinicians considering a diagnosis of syphilis. Staging of infections is based on laboratory results together with a thorough history and clinical assessment, and is done provincially by a specialized group of STI physicians for all reactive syphilis tests in BC. This process also determines if the reactive serology indicates active infection that requires treatment or a previous infection that requires no treatment. […] During this experience, I was introduced to another diagnostic tool for syphilis presentation: syphilis nucleic acid amplification by PCR (NAAT-PCR). Given that the screening EIA, the RPR, and the confirmatory TPPA tests usually become positive about 2 to 4 weeks after infection (but may take up to 90 days), there is a chance of false-negative serology during early infection. Therefore, direct detection tests such as a syphilis PCR swab that collects fluid from ulcerative lesions, or other infected tissues (e.g., rectal swab for proctitis symptoms) can enable earlier detection. A recent study was published by the BCCDC Public Health Laboratory assessing the diagnostic performance of PCR-based T. pallidum DNA detection from 2015-2020. The study found that this PCR-based syphilis testing exhibited excellent sensitivity (99.5%) and specificity (100%).

• #14 CDC Laboratory Recommendations for Syphilis Testing, United States, 2024 | MMWR

  https://www.cdc.gov/mmwr/volumes/73/rr/rr7301a1.htm

  This report provides new CDC recommendations for tests that can support a diagnosis of syphilis, including serologic testing and methods for the identification of the causative agent Treponema pallidum. These comprehensive recommendations are the first published by CDC on laboratory testing for syphilis, which has traditionally been based on serologic algorithms to detect a humoral immune response to T. pallidum. These tests can be divided into nontreponemal and treponemal tests depending on whether they detect antibodies that are broadly reactive to lipoidal antigens shared by both host and T. pallidum or antibodies specific to T. pallidum, respectively. Both types of tests must be used in conjunction to help distinguish between an untreated infection or a past infection that has been successfully treated. Limited point-of-care tests for syphilis are available in the United States; increased availability of point-of-care tests that are sensitive and specific could facilitate expansion of screening programs and reduce the time from test result to treatment. These recommendations are intended for use by clinical laboratory directors, laboratory staff, clinicians, and disease control personnel who must choose among the multiple available testing methods, establish standard operating procedures for collecting and processing specimens, interpret test results for laboratory reporting, and counsel and treat patients. Future revisions to these recommendations will be based on new research or technologic advancements for syphilis clinical laboratory science.

• #15 Treponema pallidum – Syphilis | Choose the Right Test

  https://arupconsult.com/content/treponema-pallidum

  Syphilis is usually transmitted sexually, but it can also be passed vertically from mother to child either in utero (congenital syphilis) or perinatally during birth. […] The disease is systemic and is characterized by periods of latency. Serologic testing is the preferred method of diagnosis. Two types of serologic tests are used: treponemal and nontreponemal assays. Traditional serologic screening for syphilis begins with a nontreponemal test followed by a treponemal test to confirm reactive results. Reverse screening algorithms begin with a treponemal test followed by a nontreponemal test to confirm reactive results. […] In the United States, two broad categories of serologic tests, treponemal and nontreponemal tests, are used in combination according to one of the two existing algorithms (traditional and reverse) to diagnose syphilis. Diagnosis requires the use of both types of tests.

• #16 CDC Laboratory Recommendations for Syphilis Testing, United States, 2024 | MMWR

  https://www.cdc.gov/mmwr/volumes/73/rr/rr7301a1.htm

  Treponemal tests target specific T. pallidum antigens, either intact or sonicated T. pallidum or defined recombinant proteins; these tests were traditionally used to confirm that a reactive nontreponemal (lipoidal antigen) test is the result of T. pallidum infection. Treponemal antibodies generally persist after treatment and cannot be used to distinguish between a current infection or a previously treated infection. None of the nontreponemal (lipoidal antigen) or treponemal tests can distinguish infections caused by other T. pallidum subspecies. […] Nontreponemal (lipoidal antigen) tests typically have been used as a screening test for syphilis, as a diagnostic test when patients have signs or symptoms suggestive of syphilis or have a known sexual contact, when assessing possible reinfections, and when monitoring treatment outcome. RPR and VDRL tests are still the primary screening methods used in public health laboratories in the United States; other FDA-cleared nontreponemal (lipoidal antigen) tests (e.g., the toluidine red unheated serum test [TRUST] and unheated serum reagin test [USR]) are available but are less commonly used in the United States.

• #17 Treponema pallidum – Syphilis | Choose the Right Test

  https://arupconsult.com/content/treponema-pallidum

  Nontreponemal tests detect nonspecific, antilipid (reagin) antibodies that form in response to cellular damage as a result of infection. […] Positive nontreponemal results should be followed with a treponemal assay, such as the T. pallidum particle agglutination (TP-PA) assay, for confirmation. […] Treponemal tests detect antibodies that specifically target T. pallidum; other conditions are unlikely to cause a positive result. […] Therefore, a positive treponemal screening result must be followed by a nontreponemal test to discriminate between an active and past infection. […] Diagnosing congenital syphilis can be challenging because maternal nontreponemal and treponemal immunoglobulin G (IgG) antibodies may be passed to the fetus through the placenta. […] An infant with a serum VDRL or RPR titer that is fourfold higher than the corresponding maternal titer is considered to have proven or highly probable congenital syphilis.

• #18 Syphilis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/syphilis.htm

  Nontreponemal test antibody titers might correlate with disease activity and are used for monitoring treatment response. […] A fourfold change in titer, equivalent to a change of two dilutions (e.g., from 1:16 to 1:4 or from 1:8 to 1:32), is considered necessary for demonstrating a clinically significant difference between two nontreponemal test results obtained by using the same serologic test, preferably from the same manufacturer to avoid variation in results. […] Atypical nontreponemal serologic test results (e.g., unusually high, unusually low, or fluctuating titers) might occur regardless of HIV status. […] For the majority of persons with HIV infection, serologic tests are accurate and reliable for diagnosing syphilis and evaluating response to treatment. […] Diagnosis of neurosyphilis depends on a combination of CSF tests (e.g., CSF cell count, protein, or reactive CSF-VDRL) in the presence of reactive serologic test (nontreponemal and treponemal) results and neurologic signs and symptoms.

• #19 CDC Laboratory Recommendations for Syphilis Testing, United States, 2024 | MMWR

  https://www.cdc.gov/mmwr/volumes/73/rr/rr7301a1.htm

  Endpoint titers (the highest dilution yielding a reactive result) should be determined and clearly reported when testing serum with nontreponemal (lipoidal antigen) assays that detect antibodies to lipoidal antigens (i.e., RPR and VDRL). Reports should not contain mathematical symbols such as or signs. […] Serologic tests that measure antibodies to both nontreponemal (lipoidal) and treponemal antigens related to syphilitic infections should be used in combination, when the primary test is reactive, to aid in the diagnosis of syphilis. Sole reliance on one reactive serologic test result can misclassify a patient’s syphilis status. Both the traditional syphilis screening algorithm (initial screening with nontreponemal [lipoidal antigen] assays) and the reverse syphilis screening algorithm (initial screening with treponemal immunoassays) are acceptable. The preferred algorithm should be based on laboratory resources, including staff, space and costs, test volume, and patient populations served.

• #20 Syphilis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/syphilis.htm

  Nontreponemal test antibody titers might correlate with disease activity and are used for monitoring treatment response. […] A fourfold change in titer, equivalent to a change of two dilutions (e.g., from 1:16 to 1:4 or from 1:8 to 1:32), is considered necessary for demonstrating a clinically significant difference between two nontreponemal test results obtained by using the same serologic test, preferably from the same manufacturer to avoid variation in results. […] Atypical nontreponemal serologic test results (e.g., unusually high, unusually low, or fluctuating titers) might occur regardless of HIV status. […] For the majority of persons with HIV infection, serologic tests are accurate and reliable for diagnosing syphilis and evaluating response to treatment. […] Diagnosis of neurosyphilis depends on a combination of CSF tests (e.g., CSF cell count, protein, or reactive CSF-VDRL) in the presence of reactive serologic test (nontreponemal and treponemal) results and neurologic signs and symptoms.

• #21 CDC Laboratory Recommendations for Syphilis Testing, United States, 2024 | MMWR

  https://www.cdc.gov/mmwr/volumes/73/rr/rr7301a1.htm

  Nontreponemal (lipoidal antigen) tests might be less sensitive than treponemal tests in early primary syphilis and tend to wane with time regardless of treatment. Before testing, test and specimen type should be carefully considered because serum and plasma cannot always be used interchangeably, and certain nontreponemal (lipoidal antigen) tests require heat treatment of specimens. […] A reactive result could be a false positive because of recent conditions (e.g., infections, vaccinations or injection drug use, or underlying autoimmune or other chronic conditions). Nonetheless, when performed by an experienced laboratory technician and used in conjunction with treponemal tests, clinical history, physical examination, and contact history, the nontreponemal (lipoidal antigen) tests are a highly reliable testing method for screening and determining the endpoint titer for subsequent serologic monitoring posttreatment.

• #22

  https://dermnetnz.org/topics/syphilis

  The sample is screened with a primary test (commonly EIA or TPHA) that detects IgG and IgM and confirmed with a different treponemal test. For example, a positive EIA screen is confirmed with a positive TPHA. […] After confirmation, the sample is evaluated for the serological activity of the infection by the RPR/VDRL test. […] After high-risk sexual encounters, repeat screening is advised at both six and 12 weeks post-exposure, as initial serological tests can be negative in primary syphilis. […] The prozone effect occurs when high antibody titre interferes with the formation of the antibody-antigen lattice, which is needed to see a positive flocculation test. […] False-positive serological tests occur, particularly in autoimmune disease, injecting drug use, pregnancy, and older age, but it is important to obtain a detailed history, test the sexual partner, and follow up with repeat testing, in order to ensure that the suspected false-positive result is truly false. […] Other tests that might be required particularly if neurological signs and symptoms include computed tomography (CT), magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) exam. […] A full sexual health screen should be carried out, including most importantly HIV testing.

• #23 CDC Laboratory Recommendations for Syphilis Testing, United States, 2024 | MMWR

  https://www.cdc.gov/mmwr/volumes/73/rr/rr7301a1.htm

  Treponemal tests target specific T. pallidum antigens, either intact or sonicated T. pallidum or defined recombinant proteins; these tests were traditionally used to confirm that a reactive nontreponemal (lipoidal antigen) test is the result of T. pallidum infection. Treponemal antibodies generally persist after treatment and cannot be used to distinguish between a current infection or a previously treated infection. None of the nontreponemal (lipoidal antigen) or treponemal tests can distinguish infections caused by other T. pallidum subspecies. […] Nontreponemal (lipoidal antigen) tests typically have been used as a screening test for syphilis, as a diagnostic test when patients have signs or symptoms suggestive of syphilis or have a known sexual contact, when assessing possible reinfections, and when monitoring treatment outcome. RPR and VDRL tests are still the primary screening methods used in public health laboratories in the United States; other FDA-cleared nontreponemal (lipoidal antigen) tests (e.g., the toluidine red unheated serum test [TRUST] and unheated serum reagin test [USR]) are available but are less commonly used in the United States.

• #24 Syphilis: Screening and diagnostic testing – UpToDate

  https://www.uptodate.com/contents/syphilis-screening-and-diagnostic-testing

  Treponemal tests have historically been more complex and expensive to perform than nontreponemal tests. Thus, they have traditionally been used as confirmatory tests for syphilis when the nontreponemal tests are reactive. […] A rapid definitive diagnosis of syphilis was previously made using darkfield microscopy to examine exudates of lesions for the presence of Treponema pallidum organisms. This method, which is complex, is no longer routinely available in most clinics. […] Direct methods can be used to provide a definitive diagnosis of syphilis. Since Treponema pallidum cannot be cultured in the laboratory, the organism must be identified through direct visualization or detection in clinical specimens. […] Serologic testing algorithms to diagnose syphilis should include the use of both nontreponemal and treponemal tests. Confirmatory testing is necessary due to the potential for a false-positive screening test result.

• #25 CDC Laboratory Recommendations for Syphilis Testing, United States, 2024 | MMWR

  https://www.cdc.gov/mmwr/volumes/73/rr/rr7301a1.htm

  Nontreponemal (lipoidal antigen) tests (e.g., RPR or VDRL) are not interchangeable when used to determine antibody titers; testing on follow-up samples must be performed with the same type of test. The Treponema pallidum particle agglutination test is the preferred manual treponemal test. […] Nontreponemal (lipoidal antigen) and treponemal tests should be interpreted in the same manner regardless of pregnancy status. […] Nontreponemal (lipoidal antigen) and treponemal tests should be interpreted in the same manner regardless of HIV status. […] Darkfield microscopy should be maintained if already in use or established in sexually transmitted diseases clinics where a point-of-care test for primary or secondary syphilis diagnosis would be beneficial for timely patient treatment. […] Immunohistochemistry is preferred over silver staining for formalin-fixed, paraffin-embedded tissue sections regardless of anatomic site.

• #26 Syphilis – PAHO/WHO | Pan American Health Organization

  https://www.paho.org/en/topics/syphilis

  Syphilis diagnosis is usually based on medical history, physical examination, and laboratory testing. […] Mother-to-child transmission of syphilis is preventable and can be achieved through early screening and treatment with the right antibiotic (penicillin). […] Syphilis can in most cases be easily cured with antibiotics (penicillin). A fetus can also be easily cured with treatment, and the risk of adverse outcomes to the fetus is minimal if the mother receives adequate treatment during early pregnancy ideally before the second trimester. […] Point-of-care rapid diagnostic tests (RDTs) for syphilis infection screening can provide results in 10-15 minutes and can be performed in any setting since they do not require refrigerated storage or laboratory equipment. […] Currently, WHO recommends the use, in pregnant women, of a dual RDT to screen for both HIV and syphilis infections.

• #27 Syphilis Diagnosis and Treatment: State of the Art | EMJ Reviews

  https://www.emjreviews.com/dermatology/article/syphilis-diagnosis-and-treatment-state-of-the-art/

  Treponemal tests are typically more sensitive than nontreponemal tests during early infection. […] Regardless of stage or nonserologic tests, all patients with syphilis should undergo serologic testing with both nontreponemal and treponemal tests. […] Maternal syphilis screening is part of routine standard of care in all pregnancies in many countries, including VDRL/RPR and TPHA/TPPA. […] Adequate treatment with penicillin during pregnancy is 98% effective at preventing congenital syphilis. […] Since 1943, penicillin has been an effective treatment for syphilis; with no reported resistance cases to date, it remains the recommended therapy. […] Benzathine penicillin G is the recommended treatment for syphilis in all stages. […] Treatment for both primary, secondary, and early latent syphilis consist of one administration of benzathine penicillin G 2.4 million units intramuscularly.

• #28 Diagnostic tests for syphilis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4999316/

  A reactive treponemal test most likely indicates infection by T pallidum but is not sufficient to determine disease activity and make treatment decisions. […] A negative treponemal test likely indicates the absence of syphilis and generally no further testing is required. However, recent infection cannot be ruled out and repeat testing should be considered in patients who have had a recent high-risk sexual exposure. […] The diagnosis of neurosyphilis is often initially suspected based on clinical findings coupled with positive serologic tests. Neurosyphilis is confirmed through lumbar puncture (LP). […] Confirmation of disease is done through a reactive CSF VDRL.

• #29 CDC Laboratory Recommendations for Syphilis Testing, United States, 2024 | MMWR

  https://www.cdc.gov/mmwr/volumes/73/rr/rr7301a1.htm

  Endpoint titers (the highest dilution yielding a reactive result) should be determined and clearly reported when testing serum with nontreponemal (lipoidal antigen) assays that detect antibodies to lipoidal antigens (i.e., RPR and VDRL). Reports should not contain mathematical symbols such as or signs. […] Serologic tests that measure antibodies to both nontreponemal (lipoidal) and treponemal antigens related to syphilitic infections should be used in combination, when the primary test is reactive, to aid in the diagnosis of syphilis. Sole reliance on one reactive serologic test result can misclassify a patient’s syphilis status. Both the traditional syphilis screening algorithm (initial screening with nontreponemal [lipoidal antigen] assays) and the reverse syphilis screening algorithm (initial screening with treponemal immunoassays) are acceptable. The preferred algorithm should be based on laboratory resources, including staff, space and costs, test volume, and patient populations served.

• #30 Syphilis: Laboratory Support for Screening, Diagnosis, and Monitoring | Clinical Focus | Quest Diagnostics Syphilis: Laboratory Support for Screening, Diagnosis, and MonitoringSyphilis: Laboratory Support for Screening, Diagnosis, and Monitoring

  https://testdirectory.questdiagnostics.com/test/test-guides/CF_Syphilis/syphilis-laboratory-support-for-screening-diagnosis-and-monitoring?p=h

  The CDC recommends using both a treponemal test and a nontreponemal test to screen for and diagnose syphilis, using either the traditional or reverse algorithm. Treponemal tests are specific for T pallidum but can indicate present or past infections, both treated and untreated. On the other hand, nontreponemal tests indicate active disease but are not specific to T pallidum. […] The traditional algorithm for syphilis diagnosis begins with a nontreponemal test. A reactive result reflexes to a treponemal test to confirm the reactive nontreponemal result. […] The reverse algorithm for syphilis diagnosis is becoming more widely adopted as it allows for the utilization of automated treponemal IAs. This algorithm begins with a treponemal test, often an automated IA. A reactive result will reflex to a nontreponemal test (RPR).

• #31 Syphilis: Laboratory Support for Screening, Diagnosis, and Monitoring | Clinical Focus | Quest Diagnostics Syphilis: Laboratory Support for Screening, Diagnosis, and MonitoringSyphilis: Laboratory Support for Screening, Diagnosis, and Monitoring

  https://testdirectory.questdiagnostics.com/test/test-guides/CF_Syphilis/syphilis-laboratory-support-for-screening-diagnosis-and-monitoring?p=h

  The CDC recommends using both a treponemal test and a nontreponemal test to screen for and diagnose syphilis, using either the traditional or reverse algorithm. Treponemal tests are specific for T pallidum but can indicate present or past infections, both treated and untreated. On the other hand, nontreponemal tests indicate active disease but are not specific to T pallidum. […] The traditional algorithm for syphilis diagnosis begins with a nontreponemal test. A reactive result reflexes to a treponemal test to confirm the reactive nontreponemal result. […] The reverse algorithm for syphilis diagnosis is becoming more widely adopted as it allows for the utilization of automated treponemal IAs. This algorithm begins with a treponemal test, often an automated IA. A reactive result will reflex to a nontreponemal test (RPR).

• #32 Syphilis – Serology | Public Health Ontario

  https://www.publichealthontario.ca/en/Laboratory-Services/Test-Information-Index/Syphilis-Serology

  PHO follows a reverse algorithm for syphilis testing. […] Serum specimens submitted for syphilis serology are tested following the algorithm below: […] Syphilis serology results must be interpreted in the context of the patients clinical presentation, risk factors, treatment, and exposure history. Syphilis staging cannot be done with serology results alone. […] Confirmatory testing is not performed if syphilis screen result is non-reactive. […] If not done already, repeat syphilis serology testing is recommended in 4 weeks for individuals suspected of syphilis infection or re-infection. […] Patients suspected of congenital syphilis should be referred to an infectious diseases or a paediatric specialist. […] Results are reported to the physician, authorized health care provider, or submitter as indicated on the requisition. […] Specimens that are positive for syphilis are reported to the Medical Officer of Health as per the Ontario Health Protection and Promotion Act.

• #33 SYPH1 – Overview: Syphilis IgG with Reflex, Enzyme Immunoassay, Serum

  https://www.mayocliniclabs.com/test-catalog/overview/616860

  Syphilis is caused by infection with the spirochete Treponema pallidum subspecies pallidum. The infection is systemic, and the disease is characterized by periods of latency. These features, together with the fact that T pallidum cannot be isolated in culture, mean that serologic techniques play a major role in the diagnosis and follow-up of treatment for syphilis. […] Historically, the serologic testing algorithm for syphilis included an initial nontreponemal screening test, such as the rapid plasma reagin (RPR) or the VDRL tests. […] As an alternative to the traditional syphilis screening algorithm, many laboratories utilize the reverse syphilis screening algorithm. […] Syphilis screening at Mayo Clinic is performed using the reverse algorithm, which first tests sera for T pallidum specific IgG antibodies using an automated enzyme immunoassay.

• #34 CDC Laboratory Recommendations for Syphilis Testing, United States, 2024 | MMWR

  https://www.cdc.gov/mmwr/volumes/73/rr/rr7301a1.htm

  Endpoint titers (the highest dilution yielding a reactive result) should be determined and clearly reported when testing serum with nontreponemal (lipoidal antigen) assays that detect antibodies to lipoidal antigens (i.e., RPR and VDRL). Reports should not contain mathematical symbols such as or signs. […] Serologic tests that measure antibodies to both nontreponemal (lipoidal) and treponemal antigens related to syphilitic infections should be used in combination, when the primary test is reactive, to aid in the diagnosis of syphilis. Sole reliance on one reactive serologic test result can misclassify a patient’s syphilis status. Both the traditional syphilis screening algorithm (initial screening with nontreponemal [lipoidal antigen] assays) and the reverse syphilis screening algorithm (initial screening with treponemal immunoassays) are acceptable. The preferred algorithm should be based on laboratory resources, including staff, space and costs, test volume, and patient populations served.

• #35 SYPH1 – Overview: Syphilis IgG with Reflex, Enzyme Immunoassay, Serum

  https://www.mayocliniclabs.com/test-catalog/overview/616860

  In some patients, the results of the treponemal screening test and RPR may be discordant (eg, syphilis IgG positive and RPR negative). […] In the setting of a positive syphilis IgG screening result and a negative RPR, a positive TP-PA result is consistent with either 1) past, successfully treated syphilis, 2) early syphilis with undetectable RPR, or 3) late/latent syphilis in patients who do not have a history of treatment for syphilis. […] In the setting of a positive syphilis IgG screening result and a negative RPR, a negative TP-PA result is most consistent with a falsely reactive syphilis IgG screen. […] Despite active syphilis, serologic tests may be negative in severely immunosuppressed patients such as those with AIDS. […] In very early cases of primary syphilis, serology tests for syphilis may be negative. […] In cases of untreated, late or latent syphilis, the result of rapid plasma reagin may be negative. […] Results should be considered in the context of all available clinical and laboratory data.

• #36 Syphilis: Screening and diagnostic testing – UpToDate

  https://www.uptodate.com/contents/syphilis-screening-and-diagnostic-testing

  Patients with clinical signs and symptoms of early syphilis (eg, ulcer, rash) who are tested for syphilis using an initial nontreponemal test may have a false-negative result. For such patients, a false-negative test is typically due to testing prior to antibody formation or secondary to a prozone effect.

• #37 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Syphilis-Diagnosis.aspx

  A negative result does not necessarily mean that the person does not have syphilis as the antibodies may not be detectable for up to three months after infection. The test may be repeated in three months. […] Blood tests are also recommended for pregnant women in order to detect the risk to the unborn baby and treat the mother accordingly. […] Blood tests include the Treponemal enzyme immunoassay (EIA). This can detect the immunoglobulin M (IgM) for early infection or immunoglobulin G (IgG) (the latter becomes positive at 5 weeks) or both. […] All of these will be positive in secondary and early latent syphilis. […] Venereal disease reference laboratory (VDRL) or rapid plasmin reagin (RPR) or a quantitative VDRL can be used as an indication of the stage of syphilis and is also used for monitoring treatment.

• #38

  https://dermnetnz.org/topics/syphilis

  The sample is screened with a primary test (commonly EIA or TPHA) that detects IgG and IgM and confirmed with a different treponemal test. For example, a positive EIA screen is confirmed with a positive TPHA. […] After confirmation, the sample is evaluated for the serological activity of the infection by the RPR/VDRL test. […] After high-risk sexual encounters, repeat screening is advised at both six and 12 weeks post-exposure, as initial serological tests can be negative in primary syphilis. […] The prozone effect occurs when high antibody titre interferes with the formation of the antibody-antigen lattice, which is needed to see a positive flocculation test. […] False-positive serological tests occur, particularly in autoimmune disease, injecting drug use, pregnancy, and older age, but it is important to obtain a detailed history, test the sexual partner, and follow up with repeat testing, in order to ensure that the suspected false-positive result is truly false. […] Other tests that might be required particularly if neurological signs and symptoms include computed tomography (CT), magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) exam. […] A full sexual health screen should be carried out, including most importantly HIV testing.

• #39 Syphilis: Screening and diagnostic testing – UpToDate

  https://www.uptodate.com/contents/syphilis-screening-and-diagnostic-testing

  For patients without a known history of syphilis, a diagnosis is made when both nontreponemal and treponemal tests are reactive. To determine the appropriate treatment, patients should be assessed for symptoms and stage of disease. […] Patients with a history of treated syphilis – Although treponemal tests usually remain positive after infection, titers of nontreponemal assays decline following successful therapy and usually revert to nonreactive over time. Thus, for patients with a history of treated syphilis, the presence of a positive nontreponemal test often indicates a new infection, an evolving response to recent treatment, or treatment failure. […] Discordant results often occur in patients with a history of successfully treated syphilis. In these cases, no further evaluation or treatment is needed unless there is concern for re-exposure.

• #40

  https://dermnetnz.org/topics/syphilis

  The sample is screened with a primary test (commonly EIA or TPHA) that detects IgG and IgM and confirmed with a different treponemal test. For example, a positive EIA screen is confirmed with a positive TPHA. […] After confirmation, the sample is evaluated for the serological activity of the infection by the RPR/VDRL test. […] After high-risk sexual encounters, repeat screening is advised at both six and 12 weeks post-exposure, as initial serological tests can be negative in primary syphilis. […] The prozone effect occurs when high antibody titre interferes with the formation of the antibody-antigen lattice, which is needed to see a positive flocculation test. […] False-positive serological tests occur, particularly in autoimmune disease, injecting drug use, pregnancy, and older age, but it is important to obtain a detailed history, test the sexual partner, and follow up with repeat testing, in order to ensure that the suspected false-positive result is truly false. […] Other tests that might be required particularly if neurological signs and symptoms include computed tomography (CT), magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) exam. […] A full sexual health screen should be carried out, including most importantly HIV testing.

• #41 Syphilis: Screening and diagnostic testing – UpToDate

  https://www.uptodate.com/contents/syphilis-screening-and-diagnostic-testing

  For patients without a known history of syphilis, a diagnosis is made when both nontreponemal and treponemal tests are reactive. To determine the appropriate treatment, patients should be assessed for symptoms and stage of disease. […] Patients with a history of treated syphilis – Although treponemal tests usually remain positive after infection, titers of nontreponemal assays decline following successful therapy and usually revert to nonreactive over time. Thus, for patients with a history of treated syphilis, the presence of a positive nontreponemal test often indicates a new infection, an evolving response to recent treatment, or treatment failure. […] Discordant results often occur in patients with a history of successfully treated syphilis. In these cases, no further evaluation or treatment is needed unless there is concern for re-exposure.

• #42 Syphilis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/syphilis.htm

  CSF-VDRL is highly specific but insensitive. […] For a person with neurologic signs or symptoms, a reactive CSF-VDRL (in the absence of blood contamination) is considered diagnostic of neurosyphilis. […] Laboratory testing is helpful in supporting the diagnosis of neurosyphilis; however, no single test can be used to diagnose neurosyphilis in all instances.

• #43 Diagnostic tests for syphilis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4999316/

  A reactive treponemal test most likely indicates infection by T pallidum but is not sufficient to determine disease activity and make treatment decisions. […] A negative treponemal test likely indicates the absence of syphilis and generally no further testing is required. However, recent infection cannot be ruled out and repeat testing should be considered in patients who have had a recent high-risk sexual exposure. […] The diagnosis of neurosyphilis is often initially suspected based on clinical findings coupled with positive serologic tests. Neurosyphilis is confirmed through lumbar puncture (LP). […] Confirmation of disease is done through a reactive CSF VDRL.

• #44 Diagnosis and Management of Syphilis | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0715/p283.html

  Syphilis is a sexually transmitted disease with varied and often subtle clinical manifestations. […] The diagnosis of syphilis may involve dark-field microscopy of skin lesions but most often requires screening with a nontreponemal test and confirmation with a treponemal-specific test. […] Primary syphilis is diagnosed by dark-field microscopy of a suspected lesion or by serologic testing. […] The diagnosis of secondary syphilis is confirmed by nontreponemal and treponemal-specific tests. […] Lumbar puncture is required to establish the diagnosis of neurosyphilis. […] Treponemal-specific testing (e.g., TPHA) is helpful only when the result is negative (i.e., it rules out neurosyphilis). […] Neurosyphilis should be considered in patients with signs or symptoms of neurologic involvement at any stage of T. pallidum infection and in all patients with late latent or tertiary syphilis, although asymptomatic neurosyphilis is the most common presentation.

• #45 Syphilis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/syphilis.htm

  Nontreponemal test antibody titers might correlate with disease activity and are used for monitoring treatment response. […] A fourfold change in titer, equivalent to a change of two dilutions (e.g., from 1:16 to 1:4 or from 1:8 to 1:32), is considered necessary for demonstrating a clinically significant difference between two nontreponemal test results obtained by using the same serologic test, preferably from the same manufacturer to avoid variation in results. […] Atypical nontreponemal serologic test results (e.g., unusually high, unusually low, or fluctuating titers) might occur regardless of HIV status. […] For the majority of persons with HIV infection, serologic tests are accurate and reliable for diagnosing syphilis and evaluating response to treatment. […] Diagnosis of neurosyphilis depends on a combination of CSF tests (e.g., CSF cell count, protein, or reactive CSF-VDRL) in the presence of reactive serologic test (nontreponemal and treponemal) results and neurologic signs and symptoms.

• #46 Syphilis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/syphilis.htm

  CSF-VDRL is highly specific but insensitive. […] For a person with neurologic signs or symptoms, a reactive CSF-VDRL (in the absence of blood contamination) is considered diagnostic of neurosyphilis. […] Laboratory testing is helpful in supporting the diagnosis of neurosyphilis; however, no single test can be used to diagnose neurosyphilis in all instances.

• #47 Syphilis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/syphilis.htm

  CSF-VDRL is highly specific but insensitive. […] For a person with neurologic signs or symptoms, a reactive CSF-VDRL (in the absence of blood contamination) is considered diagnostic of neurosyphilis. […] Laboratory testing is helpful in supporting the diagnosis of neurosyphilis; however, no single test can be used to diagnose neurosyphilis in all instances.

• #48 Diagnosis and Management of Syphilis | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0715/p283.html

  Syphilis is a sexually transmitted disease with varied and often subtle clinical manifestations. […] The diagnosis of syphilis may involve dark-field microscopy of skin lesions but most often requires screening with a nontreponemal test and confirmation with a treponemal-specific test. […] Primary syphilis is diagnosed by dark-field microscopy of a suspected lesion or by serologic testing. […] The diagnosis of secondary syphilis is confirmed by nontreponemal and treponemal-specific tests. […] Lumbar puncture is required to establish the diagnosis of neurosyphilis. […] Treponemal-specific testing (e.g., TPHA) is helpful only when the result is negative (i.e., it rules out neurosyphilis). […] Neurosyphilis should be considered in patients with signs or symptoms of neurologic involvement at any stage of T. pallidum infection and in all patients with late latent or tertiary syphilis, although asymptomatic neurosyphilis is the most common presentation.

• #49 Congenital Syphilis – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/infections-in-neonates/congenital-syphilis

  Diagnosis is by history and physical examination, confirmed by microscopy or serology. […] Diagnosis of early congenital syphilis is usually suspected based on maternal serologic testing, which is routinely performed early in pregnancy, and repeated in the third trimester and at delivery if risk factors are present. […] Diagnosis is confirmed by microscopic visualization of spirochetes in samples from the neonate or the placenta. […] Diagnosis of late congenital syphilis is by clinical history, distinctive physical examination findings, and positive serologic tests. […] The Hutchinson triad of interstitial keratitis, Hutchinson incisors, and 8th cranial nerve deafness is diagnostic. […] Treat with parenteral penicillin.

• #50 Diagnosis and management of congenital syphilis – Avoiding missed opportunities | Canadian Paediatric Society

  https://cps.ca/en/documents/position/congenital-syphilis

  Congenital syphilis can result in pregnancy loss and substantial morbidity in newborns. The cornerstone of prevention is identification, treatment, and follow-up during pregnancy, including of partners. Clinicians caring for newborns need to consider aspects of maternal treatment, reinfection risk, the results of paired maternal and infant syphilis serology, and infant clinical assessment. A complete risk assessment will guide effective management and follow-up of infants exposed in utero to syphilis. […] The potential for asymptomatic syphilis infection and its nonspecific or subtle maternal disease manifestations make serology the cornerstone of diagnosis. At a minimum, syphilis serology is recommended at the time of the first prenatal visit, with recommendations for repeat testing at 28 to 32 weeks and at delivery in areas with outbreaks or for individuals with ongoing risk of infection.

• #51 Congenital Syphilis – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/infections-in-neonates/congenital-syphilis

  Diagnosis is by history and physical examination, confirmed by microscopy or serology. […] Diagnosis of early congenital syphilis is usually suspected based on maternal serologic testing, which is routinely performed early in pregnancy, and repeated in the third trimester and at delivery if risk factors are present. […] Diagnosis is confirmed by microscopic visualization of spirochetes in samples from the neonate or the placenta. […] Diagnosis of late congenital syphilis is by clinical history, distinctive physical examination findings, and positive serologic tests. […] The Hutchinson triad of interstitial keratitis, Hutchinson incisors, and 8th cranial nerve deafness is diagnostic. […] Treat with parenteral penicillin.

• #52

  https://www.who.int/news-room/fact-sheets/detail/syphilis

  Syphilis diagnosis is based on the persons clinical and sexual history, physical examination, laboratory testing and sometimes radiology, as symptoms are not common or noticeable. […] Laboratory tests for syphilis include direct detection of T. pallidum through a microscope or indirect methods such as blood tests. Rapid tests are also available and can provide results in minutes, facilitating immediate treatment initiation. […] Identifying asymptomatic infection through laboratory or rapid tests and providing adequate treatment of positive cases will prevent further transmission and complications, as well as adverse pregnancy outcomes, including congenital syphilis. […] There are currently no diagnostic tests for congenital syphilis. All live or stillborn infants of women with syphilis should be examined for evidence of congenital syphilis. For live-born infants, clinical examination, radiology (if available) and laboratory tests at birth and follow up tests will help to define treatment.

• #53 Diagnosis and management of congenital syphilis – Avoiding missed opportunities | Canadian Paediatric Society

  https://cps.ca/en/documents/position/congenital-syphilis

  The preferred treatment for infectious syphilis in pregnancy consists of long-acting benzathine penicillin G, administered intramuscularly (IM), with the number of doses determined by the maternal stage of syphilis. […] The first step in caring for infants born to mothers with reactive serology is to review maternal records and determine whether adequate treatment was received and whether treatment was effective. […] All newborns, including those born to mothers with reactive syphilis NTT/TT, should have a physical examination looking for signs of CS. […] Paired maternal-infant sera samples should be ordered in the immediate post-partum period to allow comparison of NTT titers. […] Management decisions for the newborn must consider the details of maternal syphilis diagnosis, the adequacy of her treatment, reinfection risk, the results of clinical assessment and investigations of the infant, and the results of maternal and infant NTTs at birth.

• #54 Treponema pallidum – Syphilis | Choose the Right Test

  https://arupconsult.com/content/treponema-pallidum

  Nontreponemal tests detect nonspecific, antilipid (reagin) antibodies that form in response to cellular damage as a result of infection. […] Positive nontreponemal results should be followed with a treponemal assay, such as the T. pallidum particle agglutination (TP-PA) assay, for confirmation. […] Treponemal tests detect antibodies that specifically target T. pallidum; other conditions are unlikely to cause a positive result. […] Therefore, a positive treponemal screening result must be followed by a nontreponemal test to discriminate between an active and past infection. […] Diagnosing congenital syphilis can be challenging because maternal nontreponemal and treponemal immunoglobulin G (IgG) antibodies may be passed to the fetus through the placenta. […] An infant with a serum VDRL or RPR titer that is fourfold higher than the corresponding maternal titer is considered to have proven or highly probable congenital syphilis.

• #55

  https://www.who.int/news-room/fact-sheets/detail/syphilis

  Syphilis diagnosis is based on the persons clinical and sexual history, physical examination, laboratory testing and sometimes radiology, as symptoms are not common or noticeable. […] Laboratory tests for syphilis include direct detection of T. pallidum through a microscope or indirect methods such as blood tests. Rapid tests are also available and can provide results in minutes, facilitating immediate treatment initiation. […] Identifying asymptomatic infection through laboratory or rapid tests and providing adequate treatment of positive cases will prevent further transmission and complications, as well as adverse pregnancy outcomes, including congenital syphilis. […] There are currently no diagnostic tests for congenital syphilis. All live or stillborn infants of women with syphilis should be examined for evidence of congenital syphilis. For live-born infants, clinical examination, radiology (if available) and laboratory tests at birth and follow up tests will help to define treatment.

• #56 Syphilis infection – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/50

  Syphilis infection is treated with penicillin. […] Diagnosis is usually straightforward after clinical examination and serological tests. […] Diagnostic investigations include dark-field microscopy of swab from lesion, serum treponemal enzyme immunoassay (EIA), serum Treponema pallidum particle agglutination (TPPA), serum Treponema pallidum haemagglutination (TPHA), serum fluorescent treponemal antibody absorption (FTA-ABS) test, immunocapture assay, line immunoassay (LIA) serological test, serum rapid plasma reagin (RPR) test, and serum Venereal Disease Research Laboratory (VDRL) test. […] Emerging tests include Treponema pallidum polymerase chain reaction (PCR) and point of care (POC) testing with either treponemal or combination treponemal/non-treponemal antibody.

• #57 Point-of-Care Diagnostics for Diagnosis of Active Syphilis Infection: Needs, Challenges and the Way Forward

  https://www.mdpi.com/1660-4601/19/13/8172

  Laboratory test results for syphilis must be viewed and interpreted in the context of an individual’s medical history to inform the accurate clinical diagnosis and management of the case. […] The laboratory diagnosis of syphilis relies on direct detection of the pathogen (T. pallidum) or serological diagnoses of T. pallidum infection. […] Serological testing remains the mainstay for diagnosing syphilis infection because of the ease of blood collection (compared to taking samples from syphilis lesions) and the availability and affordability of serological assays. […] Rapid, point-of-care (POC) testing for syphilis has been an integral part of syphilis screening policies and is widely implemented in many countries for the prevention of mother to child transmission of syphilis (congenital syphilis).

• #58 Point-of-Care Diagnostics for Diagnosis of Active Syphilis Infection: Needs, Challenges and the Way Forward

  https://www.mdpi.com/1660-4601/19/13/8172

  Laboratory test results for syphilis must be viewed and interpreted in the context of an individual’s medical history to inform the accurate clinical diagnosis and management of the case. […] The laboratory diagnosis of syphilis relies on direct detection of the pathogen (T. pallidum) or serological diagnoses of T. pallidum infection. […] Serological testing remains the mainstay for diagnosing syphilis infection because of the ease of blood collection (compared to taking samples from syphilis lesions) and the availability and affordability of serological assays. […] Rapid, point-of-care (POC) testing for syphilis has been an integral part of syphilis screening policies and is widely implemented in many countries for the prevention of mother to child transmission of syphilis (congenital syphilis).

• #59 Syphilis – PAHO/WHO | Pan American Health Organization

  https://www.paho.org/en/topics/syphilis

  Syphilis diagnosis is usually based on medical history, physical examination, and laboratory testing. […] Mother-to-child transmission of syphilis is preventable and can be achieved through early screening and treatment with the right antibiotic (penicillin). […] Syphilis can in most cases be easily cured with antibiotics (penicillin). A fetus can also be easily cured with treatment, and the risk of adverse outcomes to the fetus is minimal if the mother receives adequate treatment during early pregnancy ideally before the second trimester. […] Point-of-care rapid diagnostic tests (RDTs) for syphilis infection screening can provide results in 10-15 minutes and can be performed in any setting since they do not require refrigerated storage or laboratory equipment. […] Currently, WHO recommends the use, in pregnant women, of a dual RDT to screen for both HIV and syphilis infections.

• #60 Syphilis – PAHO/WHO | Pan American Health Organization

  https://www.paho.org/en/topics/syphilis

  A positive result from a syphilis RDT does not distinguish between active infection and previously treated infections but it is an important resource for treatment initiation particularly among pregnant women and hard to reach populations. […] PDRs that can detect both active and past syphilis infection are now available.

• #61 New At-Home Syphilis Test Has Potential to Save Lives and Money

  https://www.ajmc.com/view/new-at-home-syphilis-test-has-potential-to-save-lives-and-money

  On Friday, August 16, the FDA authorized the First To Know Syphilis Test from NOWDiagnostics. With just a finger prick to draw a few drops of blood, the at-home test available over the counter is able to detect T pallidum within 15 minutes—no prescription needed. Positive results must be confirmed with a health care provider and to inform treatment. […] […] With the ability of a syphilis infection to go undetected for years, this new testing route also has potential to head off the downstream health care costs mentioned above and increase access to equitable care for STI testing. […] […] The marketing authorization came down under the FDA’s de novo premarket review pathway and incorporated data from a clinical study of 1270 individuals who found the test easy to use. In addition, this trial demonstrated a 99.5% accuracy rate when identifying blood specimens that were negative for syphilis and a 93.4% accuracy rate for specimens that were positive for syphilis compared with 3 FDA lab-based tests.

• #62

  https://nowdx.com/blogs/news/nowdiagnostics-first-to-know%C2%AE-syphilis-test-receives-fda-de-novo-marketing-authorization-for-over-the-counter-use?srsltid=AfmBOoqCi2ATrda8BGyysA6rXe9SkBVqGOS2MDe3rqtu9xLhnOP-d23N

  „This FDA authorization is a significant milestone in addressing the syphilis epidemic,” said Dr. Gregory Bledsoe, MD, MPH, MBA, former Surgeon General for Arkansas. […] An in-home test like this has the potential to greatly impact public health by improving access to timely detection and treatment. […] The First To Know Syphilis Test is a patented buffer-less lateral flow device that provides a qualitative rapid membrane immunochromatographic assay for detecting Treponema pallidum (syphilis) antibodies in human whole blood (capillary) from individuals suspected of having a syphilis infection. […] In a clinical study of 1,270 people, the NPA (negative percent agreement) was 99.5%, meaning it correctly identified 99.5% of negative specimens; the PPA (positive percent agreement) was 93.4%, meaning it correctly identified 93.4% of positive specimens when compared to three FDA cleared laboratory tests.

• #63 CDC Laboratory Recommendations for Syphilis Testing, United States, 2024 | MMWR

  https://www.cdc.gov/mmwr/volumes/73/rr/rr7301a1.htm

  This report provides new CDC recommendations for tests that can support a diagnosis of syphilis, including serologic testing and methods for the identification of the causative agent Treponema pallidum. These comprehensive recommendations are the first published by CDC on laboratory testing for syphilis, which has traditionally been based on serologic algorithms to detect a humoral immune response to T. pallidum. These tests can be divided into nontreponemal and treponemal tests depending on whether they detect antibodies that are broadly reactive to lipoidal antigens shared by both host and T. pallidum or antibodies specific to T. pallidum, respectively. Both types of tests must be used in conjunction to help distinguish between an untreated infection or a past infection that has been successfully treated. Limited point-of-care tests for syphilis are available in the United States; increased availability of point-of-care tests that are sensitive and specific could facilitate expansion of screening programs and reduce the time from test result to treatment. These recommendations are intended for use by clinical laboratory directors, laboratory staff, clinicians, and disease control personnel who must choose among the multiple available testing methods, establish standard operating procedures for collecting and processing specimens, interpret test results for laboratory reporting, and counsel and treat patients. Future revisions to these recommendations will be based on new research or technologic advancements for syphilis clinical laboratory science.

• #64 Syphilis Tests & Diagnosis: VDRL, RPR, EIA, TPPA, & More

  https://www.webmd.com/sexual-conditions/syphilis-diagnosis

  Syphilis is a sexually transmitted disease (STD). You can get it from having sex with someone who has it. Its easily treated with antibiotics but can lead to serious problems if its not. […] Only your doctor can know for sure whether you have syphilis. The USPSTF recommends that anyone who is at increased risk for infection undergo screening. […] Your doctor will give you a physical exam, check your genitals, and look for skin rashes or sores called chancres. Youll also have a blood test. Results typically come back within a few days. […] Blood tests can tell if your body is making the antibodies to fight the infection. The ones that fight syphilis bacteria can stay in your body for years, so your doctor can tell if you were infected, even if it were a long time ago. […] They can also diagnose syphilis by testing fluid from a sore. Thats rarely done. […] Talk to your doctor about testing and prevention of syphilis and other STDs if youre sexually active. Doctors recommend syphilis testing if youre: A man who has sex with men, A pregnant woman, HIV positive and are sexually active, Taking PrEP (Pre-Exposure Prophylaxis) for HIV prevention.

• #65 Treponema pallidum – Syphilis | Choose the Right Test

  https://arupconsult.com/content/treponema-pallidum

  The diagnosis depends on a combination of CSF studies in the presence of reactive serologic test results and neurologic signs and symptoms. […] The U.S. Preventive Services Task Force (USPSTF) recommends screening for syphilis infection in persons who are at increased risk for infection. […] Most major national organizations, including the CDC, recommend screening all pregnant individuals for syphilis at the first prenatal visit. […] Titers from nontreponemal tests (RPR or VDRL) should be used to monitor treatment response.

• #66 Syphilis: Laboratory Support for Screening, Diagnosis, and Monitoring | Clinical Focus | Quest Diagnostics Syphilis: Laboratory Support for Screening, Diagnosis, and MonitoringSyphilis: Laboratory Support for Screening, Diagnosis, and Monitoring

  https://testdirectory.questdiagnostics.com/test/test-guides/CF_Syphilis/syphilis-laboratory-support-for-screening-diagnosis-and-monitoring?p=h

  The CDC, USPSTF, and American College of Obstetricians and Gynecologists (ACOG) recommend screening pregnant individuals for syphilis at the first prenatal visit because of the serious potential complications of syphilis during pregnancy and the risk of congenital syphilis. […] Diagnosis of congenital syphilis in newborns relies on a combination of a syphilis diagnosis in the pregnant individual, the pregnant individual’s treatment history, evidence of syphilis in the newborn, and the comparison of nontreponemal antibody titers from the newborn and the pregnant individual (at delivery). […] Additional testing is indicated for syphilis patients and their sex partners following diagnosis. Patients with syphilis are often co-infected with HIV at the time of diagnosis, and syphilis increases risk of HIV acquisition. Thus, syphilis patients should be tested for HIV and other sexually transmitted infections, as indicated.

• #67 Syphilis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/syphilis/diagnosis-treatment/drc-20351762

  Your local health department may offer partner services. These help you notify your sexual partners that they may be infected. Your partners can be tested and treated, limiting the spread of syphilis. […] The preferred treatment at all stages is penicillin. This antibiotic medicine can kill the bacteria that causes syphilis. […] The recommended treatment for primary, secondary or early-stage latent syphilis is a single shot of penicillin. If you’ve had syphilis for longer than a year, you may need additional doses. […] Penicillin is the only recommended treatment for pregnant people with syphilis. […] After you’re treated for syphilis, your health care team likely will ask you to: […] Have regular blood tests and exams to make sure the penicillin treatment is working. The follow-up tests you need depend on the stage of syphilis you have.

• #68 Syphilis Diagnosis and Treatment: State of the Art | EMJ Reviews

  https://www.emjreviews.com/dermatology/article/syphilis-diagnosis-and-treatment-state-of-the-art/

  The treatment consists of benzathine penicillin G 2.4 million units intramuscularly once a week for 3 consecutive weeks. […] Neurosyphilis, otic syphilis, and ocular syphilis require treatment with intravenous aqueous crystalline penicillin G for 10-14 days. […] Clinical and serologic follow-up should follow a determined interval at 1, 3, and 6 months after therapy. […] Treatment failure should be considered if titer decline does not occur by 1 year for patients without HIV infection with primary or secondary syphilis and by 2 years for patients with HIV infection with early nonprimary, nonsecondary syphilis. […] Patients who are diagnosed with syphilis should be collaterally tested for HIV, hepatitis, and other STD. […] Syphilis is a legally reportable disease for clinicians. […] As summarised in the present review, that illustrates the current state of the art of syphilis diagnosis and treatment, the dermatologist who adequately knows syphilis can play a key role in providing the early and correct diagnosis and setting up in the proper management of patients.

• #69 Syphilis Diagnosis and Treatment: State of the Art | EMJ Reviews

  https://www.emjreviews.com/dermatology/article/syphilis-diagnosis-and-treatment-state-of-the-art/

  The treatment consists of benzathine penicillin G 2.4 million units intramuscularly once a week for 3 consecutive weeks. […] Neurosyphilis, otic syphilis, and ocular syphilis require treatment with intravenous aqueous crystalline penicillin G for 10-14 days. […] Clinical and serologic follow-up should follow a determined interval at 1, 3, and 6 months after therapy. […] Treatment failure should be considered if titer decline does not occur by 1 year for patients without HIV infection with primary or secondary syphilis and by 2 years for patients with HIV infection with early nonprimary, nonsecondary syphilis. […] Patients who are diagnosed with syphilis should be collaterally tested for HIV, hepatitis, and other STD. […] Syphilis is a legally reportable disease for clinicians. […] As summarised in the present review, that illustrates the current state of the art of syphilis diagnosis and treatment, the dermatologist who adequately knows syphilis can play a key role in providing the early and correct diagnosis and setting up in the proper management of patients.

• #70 Syphilis Diagnosis and Treatment: State of the Art | EMJ Reviews

  https://www.emjreviews.com/dermatology/article/syphilis-diagnosis-and-treatment-state-of-the-art/

  The treatment consists of benzathine penicillin G 2.4 million units intramuscularly once a week for 3 consecutive weeks. […] Neurosyphilis, otic syphilis, and ocular syphilis require treatment with intravenous aqueous crystalline penicillin G for 10-14 days. […] Clinical and serologic follow-up should follow a determined interval at 1, 3, and 6 months after therapy. […] Treatment failure should be considered if titer decline does not occur by 1 year for patients without HIV infection with primary or secondary syphilis and by 2 years for patients with HIV infection with early nonprimary, nonsecondary syphilis. […] Patients who are diagnosed with syphilis should be collaterally tested for HIV, hepatitis, and other STD. […] Syphilis is a legally reportable disease for clinicians. […] As summarised in the present review, that illustrates the current state of the art of syphilis diagnosis and treatment, the dermatologist who adequately knows syphilis can play a key role in providing the early and correct diagnosis and setting up in the proper management of patients.

• #71 CDC Laboratory Recommendations for Syphilis Testing, United States, 2024 | MMWR

  https://www.cdc.gov/mmwr/volumes/73/rr/rr7301a1.htm

  Endpoint titers (the highest dilution yielding a reactive result) should be determined and clearly reported when testing serum with nontreponemal (lipoidal antigen) assays that detect antibodies to lipoidal antigens (i.e., RPR and VDRL). Reports should not contain mathematical symbols such as or signs. […] Serologic tests that measure antibodies to both nontreponemal (lipoidal) and treponemal antigens related to syphilitic infections should be used in combination, when the primary test is reactive, to aid in the diagnosis of syphilis. Sole reliance on one reactive serologic test result can misclassify a patient’s syphilis status. Both the traditional syphilis screening algorithm (initial screening with nontreponemal [lipoidal antigen] assays) and the reverse syphilis screening algorithm (initial screening with treponemal immunoassays) are acceptable. The preferred algorithm should be based on laboratory resources, including staff, space and costs, test volume, and patient populations served.

• #72 Syphilis Diagnosis and Treatment: State of the Art | EMJ Reviews

  https://www.emjreviews.com/dermatology/article/syphilis-diagnosis-and-treatment-state-of-the-art/

  The treatment consists of benzathine penicillin G 2.4 million units intramuscularly once a week for 3 consecutive weeks. […] Neurosyphilis, otic syphilis, and ocular syphilis require treatment with intravenous aqueous crystalline penicillin G for 10-14 days. […] Clinical and serologic follow-up should follow a determined interval at 1, 3, and 6 months after therapy. […] Treatment failure should be considered if titer decline does not occur by 1 year for patients without HIV infection with primary or secondary syphilis and by 2 years for patients with HIV infection with early nonprimary, nonsecondary syphilis. […] Patients who are diagnosed with syphilis should be collaterally tested for HIV, hepatitis, and other STD. […] Syphilis is a legally reportable disease for clinicians. […] As summarised in the present review, that illustrates the current state of the art of syphilis diagnosis and treatment, the dermatologist who adequately knows syphilis can play a key role in providing the early and correct diagnosis and setting up in the proper management of patients.

• #73 Syphilis: Symptoms, Causes, and Treatments > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/syphilis

  How is syphilis treated? […] The bacteria can be completely cleared from the body using penicillin or, less commonly, other antibiotics such as doxycycline, tetracycline, or ceftriaxone. […] After treatment, periodic blood tests at six months and one year after treatment are needed to confirm that the infection has cleared. […] If syphilis has caused damage to organs or other tissues or has invaded the eyes, ears, or brain, additional treatment may be necessary. […] What is the outlook for people with syphilis? […] In the early stages (primary, secondary, or early latent syphilis), the disease is usually curable with appropriate antibiotic treatment. […] Antibiotics can eliminate the bacterial infection, but damage to organs and other tissues may require additional treatment and may be permanent.

• #74 Syphilis: Cause, Symptoms, Diagnosis, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/4622-syphilis

  Syphilis is a sexually transmitted infection (STI) that spreads when you have vaginal, anal or oral sex with someone who has the infection. Antibiotic medication treats syphilis. Untreated syphilis can lead to serious health problems, including blindness and damage to your brain, heart, eyes and nervous system. […] To test for syphilis, your provider will examine you and take a blood sample to look for signs of the infection. Your provider may remove some fluid or a small piece of skin from a syphilis sore and look at it under a microscope. The only way to know for sure if you have syphilis is by visiting your healthcare provider and getting a lab test. […] Your healthcare provider treats syphilis with antibiotics. Antibiotics are a type of medication that treats bacterial infections. Penicillin is the most commonly used medication for syphilis. How much medication you need and how long you take it depends on your syphilis stage and symptoms. […] Yes. Your healthcare provider can treat syphilis with antibiotics. Antibiotics will cure the infection, but there’s no way to repair organs damaged by syphilis.

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