Syphilis Test


Syphilis Combo Test (RPR+TPPA) in Shanghai

Syphilis is Completely Curable if Treated. The Safest Thing To Do is To Take the Test.

Also known as: Venereal disease research laboratory; VDRL; Rapid plasma reagin; RPR; Fluorescent treponemal antibody absorption test; FTA-ABS; Treponema pallidum particle agglutination assay; TPPA; Microhemagglutination assay; MHA-TP; Darkfield microscopy. Formal name: Syphilis detection test. 

Syphilis Fact

What is syphilis?

Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases.

How common is syphilis?

In the United States, health officials reported over 36,000 cases of syphilis in 2006, including 9,756 cases of primary and secondary (P&S) syphilis. In 2006, half of all P&S syphilis cases were reported from 20 counties and 2 cities; and most P&S syphilis cases occurred in persons 20 to 39 years of age. The incidence of P&S syphilis was highest in women 20 to 24 years of age and in men 35 to 39 years of age. Reported cases of congenital syphilis in newborns increased from 2005 to 2006, with 339 new cases reported in 2005 compared to 349 cases in 2006.

Between 2005 and 2006, the number of reported P&S syphilis cases increased 11.8 percent. P&S rates have increased in males each year between 2000 and 2006 from 2.6 to 5.7 and among females between  2004 and 2006.  In 2006, 64% of the reported P&S syphilis cases were among men who have sex with men (MSM).

How do people get syphilis?

Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.

What are the signs and symptoms in adults?

Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated. Although transmission occurs from persons with sores who are in the primary or secondary stage, many of these sores are unrecognized. Thus, transmission may occur from persons who are unaware of their infection.

Primary Stage The primary stage of syphilis is usually marked by the appearance of a single sore (called a chancre), but there may be multiple sores. The time between infection with syphilis and the start of the first symptom can range from 10 to 90 days (average 21 days). The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts 3 to 6 weeks, and it heals without treatment. However, if adequate treatment is not administered, the infection progresses to the secondary stage.

Secondary Stage Skin rash and mucous membrane lesions characterize the secondary stage. This stage typically starts with the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and possibly late stages of disease.

Late and Latent Stages The latent (hidden) stage of syphilis begins when primary and secondary symptoms disappear. Without treatment, the infected person will continue to have syphilis even though there are no signs or symptoms; infection remains in the body. This latent stage can last for years.  The late stages of syphilis can develop in about 15% of people who have not been treated for syphilis, and can appear 10–20 years after infection was first acquired. In the late stages of syphilis, the disease may subsequently damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Signs and symptoms of the late stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.

How does syphilis affect a pregnant woman and her baby?

The syphilis bacterium can infect the baby of a woman during her pregnancy. Depending on how long a pregnant woman has been infected, she may have a high risk of having a stillbirth (a baby born dead) or of giving birth to a baby who dies shortly after birth. An infected baby may be born without signs or symptoms of disease. However, if not treated immediately, the baby may develop serious problems within a few weeks. Untreated babies may become developmentally delayed, have seizures, or die.

How is syphilis diagnosed?

Some health care providers can diagnose syphilis by examining material from a chancre (infectious sore) using a special microscope called a dark-field microscope. If syphilis bacteria are present in the sore, they will show up when observed through the microscope.

A blood test is another way to determine whether someone has syphilis. Shortly after infection occurs, the body produces syphilis antibodies that can be detected by an accurate, safe, and inexpensive blood test. A low level of antibodies will likely stay in the blood for months or years even after the disease has been successfully treated. Because untreated syphilis in a pregnant woman can infect and possibly kill her developing baby, every pregnant woman should have a blood test for syphilis.

What is the link between syphilis and HIV?

Genital sores (chancres) caused by syphilis make it easier to transmit and acquire HIV infection sexually. There is an estimated 2- to 5-fold increased risk of acquiring HIV if exposed to that infection when syphilis is present.

Ulcerative STDs that cause sores, ulcers, or breaks in the skin or mucous membranes, such as syphilis, disrupt barriers that provide protection against infections. The genital ulcers caused by syphilis can bleed easily, and when they come into contact with oral and rectal mucosa during sex, increase the infectiousness of and susceptibility to HIV. Having other STDs is also an important predictor for becoming HIV infected because STDs are a marker for behaviors associated with HIV transmission.

What is the treatment for syphilis?

Syphilis is easy to cure in its early stages. A single intramuscular injection of penicillin, an antibiotic, will cure a person who has had syphilis for less than a year. Additional doses are needed to treat someone who has had syphilis for longer than a year. For people who are allergic to penicillin, other antibiotics are available to treat syphilis. There are no home remedies or over-the-counter drugs that will cure syphilis. Treatment will kill the syphilis bacterium and prevent further damage, but it will not repair damage already done.

Because effective treatment is available, it is important that persons be screened for syphilis on an on-going basis if their sexual behaviors put them at risk for STDs.

Persons who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed. Persons with syphilis must notify their sex partners so that they also can be tested and receive treatment if necessary.

Will syphilis recur?

Having syphilis once does not protect a person from getting it again. Following successful treatment, people can still be susceptible to re-infection. Only laboratory tests can confirm whether someone has syphilis. Because syphilis sores can be hidden in the vagina, rectum, or mouth, it may not be obvious that a sex partner has syphilis. Talking with a health care provider will help to determine the need to be re-tested for syphilis after being treated.

How can syphilis be prevented?

The surest way to avoid transmission of sexually transmitted diseases, including syphilis, is to abstain from sexual contact or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Avoiding alcohol and drug use may also help prevent transmission of syphilis because these activities may lead to risky sexual behavior. It is important that sex partners talk to each other about their HIV status and history of other STDs so that preventive action can be taken.

Genital ulcer diseases, like syphilis, can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of syphilis, as well as genital herpes and chancroid, only when the infected area or site of potential exposure is protected.

Condoms lubricated with spermicides (especially Nonoxynol-9 or N-9) are no more effective than other lubricated condoms in protecting against the transmission of STDs. Use of condoms lubricated with N-9 is not recommended for STD/HIV prevention. Transmission of an STD, including syphilis cannot be prevented by washing the genitals, urinating, and/or douching after sex. Any unusual discharge, sore, or rash, particularly in the groin area, should be a signal to refrain from having sex and to see a doctor immediately.

Why Get Tested?

To screen for or diagnose an infection with the bacterium Treponema pallidum, which causes the sexually transmitted disease (STD) syphilis

When to Get Tested?

If you have symptoms of a syphilis infection, if you have another STD, or are pregnant

Sample Required?

A scraping from a chancre in the affected area, a blood sample from a vein in your arm, or cerebrospinal fluid taken via a spinal tap, depending on the test method being used

Test Preparation Needed?


Test Sample

What is being tested?

The test is looking for presence of Treponema pallidum, the bacterium that causes syphilis. Syphilis is an infectious disease that is most often spread by sexual contact, such as through direct contact with a syphilis sore (chancre). It is easily treated but can cause severe health problems if left untreated. An infected mother can also pass the disease to her fetus, with serious and potentially fatal consequences for the baby.

According to the US Centers for Disease Control and Prevention (CDC), over 40,000 cases of syphilis were reported in 2007, including 11,466 cases of primary and secondary (P&S) syphilis. Most of the P&S syphilis cases in 2007 occurred in individuals 20 to 29 years of age.

There are several stages with syphilis. The primary stage begins about 2-3 weeks after being infected. One or more sores, called chancres appear, usually on the part of the body exposed to your partner's chancre, such as the penis or vagina. However, the chancre is usually painless and may go unnoticed, especially if it is in the rectum or on the cervix, and disappears within 4-6 weeks.

Secondary syphilis begins 2-8 weeks after the chancre first appears. It is marked by a skin rash that often is rough, red, and spotted, appearing frequently on the palms of the hands and the bottoms of the feet. There may be other symptoms as well, such as fever, fatigue, swollen lymph glands, sore throat, and body aches. If untreated, syphilis may continue into a latent stage, during which an infected person has no symptoms but continues to have the infection, and this stage can last for years. If still untreated, about 15% of people will develop the complications of late, or tertiary, syphilis. In these cases, the bacteria can damage the heart, eyes, brain, nervous system, bones, joints, or almost any other part of the body. This stage can last for years, with the final stage leading to mental illness, blindness, other neurological problems, heart disease, and death.

Syphilis can be treated with antibiotics, preferably penicillin. Newly acquired infections can be cured easily. A longer treatment may be needed to cure someone who has been infected for more than a year.

How is the sample collected for testing?

There are several different screening methods and tests; therefore, different samples are needed.

For new infections, your doctor may take a scraping from a chancre on the affected area, such as the cervix, penis, anus, or throat. Your doctor may have blood drawn from a vein in your arm for an additional test. If you have late or latent stages of the disease with suspected brain involvement (neurosyphilis), your doctor will order a spinal tap to check your cerebrospinal fluid (CSF) for infection.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

The Test

How is it used?

The tests are used to screen for and diagnose infection with Treponema pallidum, the bacterium that causes syphilis. Screening of all pregnant women is recommended by the US Preventive Services Task Force, preferably at the first prenatal visit. Many states require a blood test for syphilis when a couple is applying for a marriage license in order to help prevent the spread of the infection to others, especially a newborn baby.

There are several methods that can be used to test for syphilis. One method used in diagnosis of early cases involves looking for the bacterium in scrapings from the chancre using a special instrument called a dark-field microscope. Other methods require a blood sample in which antibodies can be detected. These include:

  • For screening – VDRL which stands for “venereal disease research laboratory” test and rapid plasma reagin test (RPR)
  • For diagnosis - fluorescent treponemal antibody absorption test (FTA-ABS) and Treponema pallidum particle agglutination assay (TPPA) A method called microhemagglutination assay, MHA-TP, is rarely used any more.

Response to treatment can be determined with a follow-up RPR test, and the FTA-ABS test is used to confirm a positive VDRL or RPR screening test. In late or latent syphilis, cerebrospinal fluid (CSF) may be obtained using a spinal tap and then tested in order to diagnose brain involvement (neurosyphilis).

When is it ordered?

A doctor may order the test:

  • if you have symptoms, such as a chancre on the genitals or throat;
  • if you are being treated for another sexually transmitted disease, such as gonorrhea;
  • if you are pregnant, because untreated syphilis can infect and even kill a developing fetus;
  • or if you complain of non-specific symptoms that resemble those of syphilis, to determine the exact cause of your illness. If you are infected, you should have follow-up blood tests at 3, 6, 12, and 24 months to make sure the infection is gone following treatment.

What does the test result mean?

If a scraping reveals presence of the syphilis bacterium (a positive test), you have an infection that requires treatment with a course of antibiotics, preferably penicillin.

For the blood tests that detect the antibodies that the body produces to combat infection, a positive test indicates that you have either a current or past infection. However, a negative test does not always mean that you do not have syphilis.

Antibodies may not be able to be detected for up to three months after exposure to the bacteria, and the antibodies remain in the body for years. If you have had a past infection with syphilis and were treated, your test results could still be positive. For example, a FTA-ABS test may remain positive for life even if you have been treated. To avoid being retreated, keep a record of the previous treatment and show it to your doctor. Following treatment, syphilis antibodies should be lower and can be monitored with the titered RPR test; if they remain the same or rise, you may have a persistent infection.

The different tests available to screen and diagnose syphilis vary in their accuracy depending on the stage of disease. For example, the VDRL and RPR tests have highest sensitivity during the middle stages.

Is there anything else I should know?

Screening tests for syphilis are not highly specific and may give a false positive result. For example, having HIV, Lyme disease, malaria, lupus, or certain types of pneumonia may cause a false positive result on the VDRL and RPR tests. Positive tests should be confirmed with a more specific test method, such as FTA-ABS.

If you are sexually active, you should consult your doctor about any suspicious rash or sore in the genital area.

If you are infected, tell your sexual partner(s) to get tested and treated.

If you are infected, your risk of contracting other sexually transmitted diseases increases, including the risk of being infected with HIV, the virus that causes AIDS. The chancres caused by syphilis make it easier to transmit and acquire HIV.

Common Questions

How long does it take to get results from a syphilis test?

If the specimen is examined microscopically by the doctor, then results could be immediately available. Otherwise, blood and CSF tests are sent to a laboratory and results could take three to five days.

Syphilis is an infectious disease caused by bacteria which penetrates broken skin or mucous membranes on the penis or the vaginal parts. It may also infect the mucus membranes of the mouth.

Transmission occurs most frequently by sexual contact. Syphilis can also be transferred to the unborn baby via the placenta after the 10th week of pregnancy.

Syphilis has 3 stages. In the primary stage, painless sores called chancres appear 10 days to 6 weeks after exposure, and can disappear on their own. The secondary stage can begin a week to 6 months after the primary stage. A skin rash is the hallmark of this stage, and lesions may appear again. The lesions are very infectious in this stage. A third phase follows during which no symptoms are present, but syphilis can be diagnosed by blood tests.

If the disease has not been effectively treated, bacteria can continue to invade the body, and there will be a relapse. In this phase, there is a widespread infection that infects the internal organs, bones, the heart, and the brain. Approximately 30,000 cases of syphilis in adults are reported each year in the United States. Congenital syphilis occurs in 1:10,000 live births. Transplacental (from mother to fetus) transmission of syphilis can result in stillbirth. The risk of transmission to the fetus in untreated primary or secondary syphilis is approximately 100%.

Treatment is usually 100% effective and results in a cure with simple antibiotics from your neighborhood doctor.

Syphilis is not an old fashion disease. It is very popular today. Syphilis is curable, but silent and infects all organs of the body. You may have no symptoms until later in life when it has done damage to your brain and heart

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