Flowchart for syphilis screening and confirmation (accessible version)
Updated 4 December 2025
Applies to England
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For reporting please use the results table and reporting comments for syphilis.
1. Perform screening test using a syphilis EIA or CLIA: is syphilis total antibody detected or equivocal?
If no, report as treponemal infection not detected. End of laboratory pathway.
If yes, go to step 2.
2. Perform Treponemal test 2 and RPR: is Treponemal test 2 positive?
If no, go to step 3.
If yes, go to step 4.
3. Is RPR positive?
If no, report as inconclusive result and request repeat serology in 2 weeks. Refer to reporting table.
If yes, this is an unusual result. Repeat all tests on current sample and if reproduced report as inconclusive and repeat serology in 2 weeks. Refer to reporting table.
4. Is RPR titre > 1:16?
If yes and RPR titre is > 1:16, report as recent or active treponemal infection. End of laboratory pathway.
If no and RPR titre is ≤ 1:16, report as consistent with treponemal infection at some time. End of laboratory pathway.