Syphilis

Traditional testing algorithm

Primary stage Secondary stage Latent stage Tertiary stage
Symptoms painless genital ulcers (chancre)
  • Skin rash covering the whole body (25 % of infected)
  • Fever, generalized lymphadenopathy, hepatitis, spleno-megaly, periostitis, arthritis, and glomerulonephritis are possible
 asymptomatic 10 % of untreated patients:
  • Gummatous syphilisa
  • Late neurosyphilisb
  • Cardiovascular syphilisc
Treponemal IgM rising high declining negative
Treponemal IgG rising high high high
Non-treponemal IgM/IgG* rising high high (untreated)
declining (treated)		 high (untreated)
low (treated)

* antibodies against cellular lipids (mostly cardiolipin)
a Nodules/plaques or ulcers.
b Meningitis, cranial nerve dysfunction, meningovascular syphilis (stroke, myelitis), and parenchymatous neurosyphilis (general paresis, tabes dorsalis).
c Aortic regurgitation, stenosis of coronary ostia, and aortic aneurysm.

Adapted from:

  1. U.S. Department of Health and Human Services, Department of Health and Human Services, Centers for Disease Control and Prevention (CDC). Syphilis CDC Fact Sheet. [Internet; updated 2023 Apr; cited 2023 Nov]. Available from: https://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm.
  2. Peeling RW and Ye H. Diagnostic tools for preventing and managing maternal and congenital syphilis: an overview. Bull World Health Org. 2004;82:439-46.
Product Description Tests Product page
Elecsys® Syphilis a) Electrochemiluminescence immunoassay (ECLIA) for the qualitative detection of total antibodies against bacterial TpN15, TpN17 and TpN47 in human serum and plasma 100
Elecsys® Syphilis a) 200
Elecsys® Syphilis b) 300
RPR2 c) lmmunoturbidimetric assay for the quantitative determination of syphilitic anti-lipid antibodies in human serum and plasma 250
TPLA2 c) lmmunoturbidimetric assay for the quantitative determination of anti-Tregonema pallidum antibodies in human serum and plasma 250

a) for use on the cobas® e 411 analyzer and the cobas® e 601 / 602 modules
b) for use on the cobas 402 and cobas® e 801 analytical units
c) for use on the cobas® c 501/502 clinical chemistry analyzers

Adapted from:

  1. Peeling RW, et al. Syphilis. Nat Rev Dis Primers. 2017;3:17073.
  2. Janier M, et al. European Guideline on the Management of Syphilis. J Eur Acad Dermatol Venereol. 2014;28:1581-93.
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Step 1

Perform non-treponemal test

Non-treponemal test
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Step 2

Treponemal test

Treponemal test
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Step 3

Repeat treponemal test

Treponemal test
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Summary

No serologic evidence of syphilis

No further action is needed in most cases.

Does not rule out incubating or early primary infection.

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Summary

Confirmed syphilis infection
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Consider the clinical background and history of the patient before initiating treatment.

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Summary

Syphilis unlikely

​​​​​​​Non-treponemal test probably false positive.

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Summary

Serology consistent with latent syphilis

​​​​​​​Treat accordingly.

Back
Next Restart simulation
Step
Result
Interpretation
1
Non-treponemal test = ...
waiting for input
1

Non-treponemal test = non-reactive

No serologic evidence of syphilis

No further action is needed in most cases.

Does not rule out incubating or early primary infection.

1

Non-treponemal test = reactive

Possible syphilis infection
Perform confirmatory treponemal test.

2
Treponemal test = ...
waiting for input
2

Treponemal test = non-reactive

Biological false positive or recent exposure
Repeat treponemal test after approx. 2 to 4 weeks.

2

Treponemal test = reactive

Confirmed syphilis infection

3
Repeat treponemal test = ...
waiting for input
3

Repeat treponemal test = non-reactive

Syphilis unlikely​​​​​​​

3

Repeat treponemal test = reactive

Serology consistent with latent syphilis​​​​​​​

End of test sequence