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Curr Opin Infect Dis. 2012 Feb;25(1):79-85. doi: 10.1097/QCO.0b013e32834e9a3c.

Which algorithm should be used to screen for syphilis?

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Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA.



A growing number of laboratories have implemented a reverse screening algorithm for syphilis testing, which has created confusion among many healthcare providers. This review focuses on recent data addressing the clinical and economical impact of reverse screening and discusses the advantages and limitations of the traditional and contemporary algorithms.


Screening for syphilis using a treponemal assay detects a higher number of patients with reactive results compared to traditional screening by rapid plasma reagin (RPR). Furthermore, a significant percentage of patients who are reactive by a treponemal screening assay are nonreactive by RPR. These discordant results may occur in patients with past, treated or untreated syphilis; early syphilis; or no syphilis. Recent reports suggest that the reverse screening algorithm may result in increased patient follow-ups, overtreatment, and potentially higher cost. However, other data suggest that reverse screening facilitates the detection of latent and early syphilis, while offering an objective and automated screening approach.


The Centers for Disease Control and Prevention currently recommends syphilis screening with a nontreponemal test. However, as laboratories continue to implement the reverse screening algorithm, it is important that samples with discordant screen-reactive, RPR-nonreactive results be tested by a second treponemal assay to assist in the interpretation of results.

[Indexed for MEDLINE]

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