A 34-year-old woman is screened for syphilis and has a positive Treponema pallidum-specific enzyme-linked immunoassay (EIA). The laboratory performs a reflexive Rapid Plasma Reagin (RPR) test that is nonreactive. Tests for HIV, Neisseria gonorrhoeae, and Chlamydia trachomatis are negative. She has no medical problems, takes no medications, and does not use illicit drugs. She has been sexually active with the same male partner for the past 3 years. She has no prior history of any sexually transmitted infections, and has never been tested or treated for syphilis. She is asymptomatic and the physical examination is normal.
Which one of the following is the most appropriate next step in the evaluation of this woman?
Figure 1. Syphilis Serologic Screening: Reverse Sequence Algorithm
*Does not rule out recent infection as persons with recent infection can have a false-negative EIA or CIA test.
The reverse serologic screening algorithm uses an initial treponemal test for screening, followed by a nontreponemal test confirmation. A specimen with reactive EIA/CIA results should be tested reflexively with a quantitative nontreponemal test (RPR or VDRL).
Abbreviations: RPR = Rapid Plasma Reagin; VDRL = Venereal Disease Research Laboratory; TP-PA = Treponema pallidum particle agglutination.
The reverse serologic screening algorithm uses an initial treponemal test for screening, followed by a nontreponemal test confirmation. A specimen with reactive EIA/CIA results should be tested reflexively with a quantitative nontreponemal test (RPR or VDRL).
Abbreviations: RPR = Rapid Plasma Reagin; VDRL = Venereal Disease Research Laboratory; TP-PA = Treponema pallidum particle agglutination.
Source: Centers for Disease Control and Prevention (CDC). Discordant results from reverse sequence syphilis screening--five laboratories, United States, 2006-2010. MMWR Morb Mortal Wkly Rep. 2011;60:133-7.
Figure 2. Syphilis Serologic Screening: Traditional Sequence Algorithm
The traditional serologic screening sequence algorithm uses a quantitative nontreponemal test (RPR or VDRL) for screening followed by a treponemal test for confirmation of positive screening tests.
Abbreviations: RPR = rapid plasma reagin; VDRL = Venereal Disease Research Laboratory; TP-PA = Treponema pallidum particle agglutination.
Abbreviations: RPR = rapid plasma reagin; VDRL = Venereal Disease Research Laboratory; TP-PA = Treponema pallidum particle agglutination.
Source: Centers for Disease Control and Prevention (CDC). Discordant results from reverse sequence syphilis screening--five laboratories, United States, 2006-2010. MMWR Morb Mortal Wkly Rep. 2011;60:133-7.
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Question Last Updated
February 4th, 2025
February 4th, 2025
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