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Serologic Testing for Syphilis


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Diagnosis: Contemporary Algorithm

Slide 12

April 2011

The contemporary algorithm for syphilis serology has several advantages, including a specific screening test that yields an objective result. In addition, this approach lends itself to high throughput, automated screening by methods such as EIA, chemiluminescence immunoassay or multiplex flow immunoassay technologies, so this is algorithm is often appealing to high-volume reference laboratories.

However, this reverse testing algorithm comes with several significant limitations that we should discuss. First, most treponemal assays, especially those based on newer technologies such as EIA or multiplex platforms, are more expensive compared to RPR. Second, treponemal tests remain positive following therapy, so the implementation of the reverse algorithm has led to many health care providers and laboratorians asking, “How do we interpret results from patients that are treponemal screen positive, but negative by nontreponemal tests?”

Diagnosis: Contemporary Algorithm


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