Use and interpretation of serologic tests for the diagnosis of syphilis

Syphilis has become a disease of low prevalence in the general population of the United States. In addition, serologic tests for syphilis are not as specific as commonly believed. These two facts cast doubt on a diagnosis of syphilis based solely on serologic evidence. However, ordering tests selectively on the basis of clinical evidence and reserving treponemal tests for reagin-reactive specimens is an effective strategy for dealing with these diagnostic uncertainties.