Syphilis: Treponemal Antibodies With Reflex to RPR and RPR Titer, Reverse Screening and Diagnosis Algorithm

CPT: 86780
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Synonyms

  • Syphilis
  • Trep-Sure™
  • Treponemal

Test Includes

Reflex to qualitative rapid plasma reagin (RPR) on positives


Expected Turnaround Time

1 - 4 days


Related Documents


Specimen Requirements


Specimen

Serum


Volume

1 mL


Minimum Volume

0.5 mL (Note: This volume does not allow for repeat testing.)


Container

Red-top tube or gel-barrier tube


Storage Instructions

Room temperature


Stability Requirements

Temperature

Period

Room temperature

14 days

Refrigerated

14 days

Frozen

14 days

Freeze/thaw cycles

Stable x3


Causes for Rejection

Hemolysis; lipemia; gross bacterial contamination; plasma specimen


Test Details


Use

This test is intended to support screening and diagnosis of syphilis infections. This test aligns with the CDC-supported reverse serologic testing algorithm for syphilis using a combination of both treponemal and nontreponemal antibody tests. The reverse syphilis testing algorithm begins with a treponemal antibody assay. Positive samples reflex to RPR (nontreponemal). If the RPR is positive, RPR titer will be determined. If the RPR is negative, a second treponemal antibody assay will be performed to confirm the presence of treponemal antibodies. Interpretation of results obtained must take into account patient symptoms and clinical history.


Limitations

Treponemal antibodies typically persist for life despite treatment; thus, this assay cannot be used to monitor response to treatment or to assess treatment outcomes. False positive treponemal antibody results have been observed in individuals with nonsyphilis treponemal infections (bejel, pinta, yaws).


Methodology

Enzyme immunoassay (EIA) with reflex to charcoal flocculation if reactive


Additional Information

Treponemal antibody (CIA)

RPR

RPR titer

Treponemal antibody (EIA)

Interpretation

Nonreactive

Not done

Not done

Not done

No laboratory evidence of syphilis. If recent exposure is suspected, submit a new sample for testing in 2-4 weeks.

Reactive

Nonreactive

Not done

Nonreactive

Treponemal antibodies not confirmed. Inconclusive for syphilis; potentially early syphilis, possible false positive. If recent exposure is suspected, submit a new sample for testing in 2-4 weeks. If clinical suspicion is low no further evaluation is necessary.

Reactive

Nonreactive

Not done

Reactive

Treponemal antibodies detected. Consistent with past or current (potentially early) syphilis. Clinical evaluation should be performed to identify current signs and symptoms or past history of infection. If past history of treatment reported, no further management is needed unless symptomatic or recent exposure suspected. If no symptoms or past history of treatment, and if recent exposure is suspected, submit a new sample for testing in 2-4 weeks.

Reactive

Reactive

1:1 or greater

Not done

Treponemal and nontreponemal antibodies detected. Consistent with past or current syphilis. Clinical evaluation should be performed to identify current signs and symptoms or past history of infection.


References

Association of Public Health Laboratories (APHL). Suggested Reporting Language for Syphilis Serological Testing, 2nd ed. August 2020. Accessed via APHL website at https://www.aphl.org/programs/infectious_disease/std/Pages/Syphilis.aspx.
Workowski KA, Bachman LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.34292926

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
082345 T pallidum Screening Cascade 47236-5 082356 T pallidum Antibodies 47236-5
Reflex Table for T pallidum Antibodies
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 006099 RPR 006097 RPR 20507-0
Reflex 2 006476 RPR, Quant 006476 RPR, Quant titer 31147-2
Reflex Table for T pallidum Antibodies
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 006099 RPR 006097 RPR 20507-0
Reflex 2 082348 Treponemal Antibodies, TPPA 082349 Treponemal Antibodies, TPPA 24312-1
Reflex Table for T pallidum Antibodies
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 006099 RPR 006097 RPR 20507-0
Reflex 2 082348 Treponemal Antibodies, TPPA 010003 Interpretation: N/A

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