How is Syphilis Tested & Diagnosed?

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Because of the fact that symptoms related to syphilis can disappear or may never present themselves at all, diagnosis is very difficult. Therefore it is important to see your doctor as soon as you find a sore on your genital area or an extensive rash. Syphilis is confirmed through laboratory testing:

  • Microscopically. A sample from an open sore can be viewed to determine if the bacteria is present.
  • Blood Sample. Syphilis can also be confirmed through blood analysis.

What tests are used for Syphilis?

There are three types of tests which screen for Syphilis: the venereal disease research laboratory (VDRL) test, the enzyme immunoassay (EIA) test, and the rapid plasma reagin (RPR) test. All of them detect the Syphilis antibodies in the blood, and a positive EIA test is usually confirmed with a VDRL or RPR test. To diagnose Syphilis in an early stage, the darkfield microscopy test or the fluorescent treponemal antibody absorption test can check for antibodies to the Syphilis bacteria during the first 3 to 4 weeks after exposure.

The TPPA test is used to confirm a Syphilis positive diagnosis after another of the above tests have been positive; the same is true for the Microhemagglutination assay (MHA- TP). So no matter what, Syphilis tests will help you get a definite diagnose.

Testing window for Syphilis

All STDs have a test window period, which depends on how long it takes for the STD to incubate and manifest in the system. Though a lot of STDs can be asymptomatic, this does not mean they are not there.

You can have no symptoms and still spread the disease to your partner(s). The Syphilis test window period is usually ten to ninety days. Remember that even if your risk level is low, you should ideally get yourself tested at least once a year. If you doubt the results of your test, get a re-test!

Test accuracy for Syphilis

The Syphilis test accuracy may give a false positive as they are not highly specific; having some types of a disease unrelated to Syphilis can have a test yield a false-positive as the antibodies used to fight diseases like HIV, Lyme, Malaria or certain types of pneumonia are similar.

If you have a positive result, an FTA should be conducted in order to make sure the first Syphilis test was accurate and didn't yield a false positive. Should you be infected, make sure to notify your sexual partners so they get treated as well. Also remember that if you are infected, Syphilis increases your risk of contracting other STDs.

A Guide to Rapid Plasma Reagin (RPR) Test for Syphilis

A RPR Syphilis test requires a blood sample and screens the sample for antibodies which fight the Syphilis bacteria antibodies, which are produced by those infected with Syphilis. However, these antibodies are similar to others which is why the RPR can give a false-positive.

A further test will be done to see whether or not the RPR was a false-positive, or if you really have Syphilis. If you're currently being treated for Syphilis, an RPR Syphilis test will keep tabs on how the treatment is working, checking for the levels of Syphilis antibodies in the blood.

Like all STD tests, RPR Syphilis tests are not 100% accurate, but this should not keep you from getting tested and re-tested; keep yourself and your partner(s) healthy!

What Does False-Positive Syphilis Test Mean?

False positive Syphilis tests can be confirmed by performing another test (called FTA) to confirm the diagnosis of the first test. Annually getting yourself tested is the first step to take in order to lead a healthy sexual lifestyle, whether you're at high or low risk, it is the right thing to do.

A false positive Syphilis test can occur due to there being similar antibodies as the type which defend against Syphilis. Those kinds of infections can be chickenpox, Lyme disease, or an autoimmune disease. There are however cases in which someone scores a false positive test for no identifiable reason.

If you test repeatedly with a false positive Syphilis test, then it is best to just do the FTA test, without the RPR screening beforehand.

Mark Riegel, MD

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