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CDC Study – Reverse Sequence Syphilis Screening Algorithm

February 2011

CDC Study on Reverse Sequence Syphilis Screening Algorithm

Traditionally, the screening algorithm for syphilis has used a nontreponemal screening test (i.e., RPR or VDRL), followed by a confirmatory test for treponemal antigen (i.e., FTA-Abs or TP-PA). However, some municipalities with a high volume of syphilis testing, such as New York City, have begun to use a new algorithm with automated EIA as an initial treponemal screen, followed by the nontreponemal RPR to confirm the need for treatment.

To determine whether additional recommendations were warranted due to this alternative testing algorithm, CDC analyzed data from five studies of reverse sequence syphilis screening. A high percentage (56.7%) of specimens with a reactive EIA/CIA screening test had a nonreactive nontreponemal RPR test, suggesting an increased rate of false-positive results according to the alternative testing algorithm. The report concludes that the traditional testing should be used with nontreponemal tests for screening and treponemal testing be used to confirm syphilis.

For more the full CDC report, click here: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6005a1.htm?s_cid=mm6005a1_w

For the New York State Department of Health AIDS Institute’s guidelines, see Management of STIs in HIV-Infected Patients: Syphilis.