Flowchart for syphilis screening and confirmation when using a second screening assay (accessible version)
Updated 25 May 2022
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 TPPA/TPHA: is TPPA/TPHA positive?
If no, go to step 3.
If yes, go to step 7.
3. Perform second EIA or CLIA: is syphilis total antibody detected or equivocal?
If no, report as treponemal infection not detected. End of laboratory pathway.
If yes, perform RPR. Go to step 4.
4. Is RPR positive?
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.
If no, report as inconclusive result and request repeat serology in 2 weeks. Refer to reporting table.
5. Perform RPR: is RPR titre > 1:16 or ≤ 1:16?
If > 1:16, report as recent or active treponemal infection. End of laboratory pathway.
If ≤ 1:16, report as consistent with treponemal infection at some time. End of laboratory pathway.