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Updated: May 26, 2026

Procedures for In Vitro Cultivation of Treponema pallidum, the Syphilis Spirochete

Procedures for In Vitro Cultivation of Treponema pallidum, the Syphilis Spirochete

Published on: January 24, 2025

Which algorithm should be used to screen for syphilis?

Matthew J Binnicker¹

¹Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA. binnicker.matthew@mayo.edu

Current Opinion in Infectious Diseases

|December 14, 2011

Summary

This summary is machine-generated.

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Reverse syphilis screening using treponemal assays detects more reactive cases than traditional RPR screening, leading to potential confusion and increased costs. Further testing is recommended for discordant results to accurately diagnose syphilis.

Area of Science:

Clinical diagnostics
Infectious disease screening
Syphilis testing algorithms

Background:

Laboratories increasingly use reverse screening for syphilis testing, causing confusion among healthcare providers.
Traditional screening relies on rapid plasma reagin (RPR) assays, while newer methods employ treponemal assays.

Purpose of the Study:

To review recent data on the clinical and economic impact of reverse syphilis screening.
To discuss the advantages and limitations of traditional and contemporary syphilis screening algorithms.

Main Methods:

Review of recent clinical and economic data on syphilis screening algorithms.
Analysis of discordant results between treponemal and RPR assays.

Main Results:

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Last Updated: May 26, 2026

Procedures for In Vitro Cultivation of Treponema pallidum, the Syphilis Spirochete

Procedures for In Vitro Cultivation of Treponema pallidum, the Syphilis Spirochete

Published on: January 24, 2025

Treponemal assays detect more reactive syphilis cases than RPR, including a significant percentage of discordant results.
Discordant results may indicate past syphilis, early infection, or no infection, potentially leading to increased follow-ups and costs.
Reverse screening may facilitate early syphilis detection and offers an automated approach.

Conclusions:

The CDC currently recommends nontreponemal (RPR) testing for syphilis screening.
Laboratories implementing reverse screening should test discordant (reactive treponemal, nonreactive RPR) samples with a second treponemal assay for accurate interpretation.