Sorted By Test Name - Mayo Medical Laboratories

SYPGN
32184
of reverse screening results Patient history Test and result Interpretation Follow-up EIA/CIA/MFI RPR
TP-PA Unknown history of syphilis Non-reactive N/A N/A No serologic evidence of syphilis None,
unless clinically indicated (eg, early syphilis) Unknown history of syphilis Reactive Reactive N/A
Untreated or recently treated syphilis See CDC treatment guidelines Unknown history of syphilis
Reactive Non-reactive Non-reactive Probable false-positive screening test No follow-up testing, unless
clinically indicated Unknown history of syphilis Reactive Non-reactive Reactive Possible syphilis (eg,
early or latent) or previously treated syphilis Historical and clinical evaluation required Known history of
syphilis Reactive Non-reactive Reactiveor N/A Past, successfully treated syphilis None CIA,
chemiluminescence immunoassay; EIA, enzyme immunoassay; MFI, multiplex flow immunoassay; N/A,
not applicable; RPR, rapid plasma reagin; TP-PA, Treponema pallidum particle agglutination.
http://www.cdc.gov/std/treetment/2010/
Reference Values:
Negative
Clinical References: 1. Tramont EC: Treponema pallidum (Syphilis). In Principles and Practice of
Infectious Diseases. Fifth edition. Edited by GL Mandell, JE Bennet, R Dolin. New York Churchill
Livingstone, 2000, pp 2474-2491 2. CDC. Discordant results from reverse sequence syphilis
screening-five laboratories, United States, 2006-2010. MMWR Morb Mortal Wkly Rep
2011;60(5):133-137 3. Binnicker MJ, Jespersen DJ, Rollins LO: Direct comparison of the traditional and
reverse syphilis screening algorithms in a population with a low prevalence of syphilis. J Clin Microbiol
2012 Jan;50(1):148-150
Syphilis Antibody, IgG, Serum
Clinical Information: Syphilis is a disease caused by infection with the spirochete Treponema
pallidum. The infection is systemic and the disease is characterized by periods of latency. These features,
together with the fact that Treponema 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 venereal disease research laboratory (VDRL) tests. Because these tests
measure the host's antibody response to nontreponemal antigens, they lack specificity. Therefore, a
positive result by RPR or VDRL requires confirmation by a treponemal-specific test, such as the
fluorescent treponemal antibody-absorbed (FTA-ABS) or microhemagglutination assay (MHA-TP).
Although the FTA-ABS and MHA-TP are technically simple to perform, they are labor intensive and
require subjective interpretation by testing personnel. Recently, EIA and multiplex flow immunoassays
(MFI) were introduced to assess serologic response to Treponema pallidum. The Bio-Rad BioPlex
Syphilis IgG assay is an example of MFI technology, which utilizes specific, treponemal antigens coated
on microspheres for the detection of IgG-class antibodies to Treponema pallidum. The BioPlex Syphilis
IgG assay is highly sensitive and specific (see Supportive Data), and allows for an objective interpretation
of results. Due to several factors including the low prevalence of syphilis in the United States, the
increased specificity of treponemal assays, and the objective interpretation of MFI and EIA technology,
initial serologic testing by a treponemal-specific assay (eg, EIA or MFI) is now commonly performed in
clinical laboratories. Specimens testing positive by the treponemal-specific assay are then tested by RPR
to provide supplementary serologic data, as well as to provide an indication of the patient's disease state
and history of treatment. During early primary syphilis, the first antibodies to appear are of the IgM-class,
with IgG-class antibodies reaching significant titers later in the primary phase. As the disease progresses
into the secondary phase, IgG-class antibodies to Treponema pallidum reach peak titers, and may persist
indefinitely regardless of the disease state or prior therapy. For prenatal syphilis screening, the IgG test is
recommended. IgM testing should not be performed during routine pregnancy screening unless clinically
indicated. Treponema pallidum IgG antibodies persist indefinitely, regardless of the course of the disease.
If treatment of an original Treponema pallidum infection was not monitored, a diagnosis of reinfection
may actually represent either a resurgence of an inadequately treated earlier infection or persistent IgG
antibodies from a resolved infection.
Useful For: An aid in the diagnosis of active Treponema pallidum infection Routine prenatal screening
Interpretation: A positive IgG treponemal test suggests infection withTreponema pallidum at some
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