VDRL; RPR (Rapid Plasma Reagin)

There are other tests available that are required for the diagnosis of syphilis such as: 1. Antibody tests (serology): Antibody tests are most commonly used and they detect antibodies in the blood and cerebrospinal fluid (CSF). In this, there are two types of tests available for syphilis testing, nontreponemal antibody test and treponemal antibody test. Any of these two types can be used for syphilis screening, but it must be followed by a second test that uses a different method to confirm a positive result and to diagnose active syphilis. · Nontreponemal antibody tests—These are called "nontreponemal", as they detect antibodies that are not specifically targeted against the syphilis bacteria Treponema pallidum. Besides syphilis, these antibodies can also be produced in several other conditions (false-positive results). The tests are highly sensitive but are non-specific in nature. False-positive results can be seen in IV drug use, pregnancy, Lyme disease, certain types of pneumonia, malaria, tuberculosis, or certain autoimmune disorders including lupus. A positive screening result must be confirmed with a more specific (treponemal) test. Nontreponemal tests include RPR (Rapid Plasma Reagin) and VDRL (Venereal Disease Research Laboratory) test. · Treponemal antibody tests: These blood tests detect antibodies that specifically target Treponema pallidum. They are highly specific for syphilis. However, once a person is infected and these antibodies develop, they remain in the blood for life. On the other hand, nontreponemal antibodies typically disappear in an adequately treated person after about 3 years. Therefore, a positive treponemal screening result must be followed by a nontreponemal test (such as RPR) to differentiate between an active infection (or reinfection) and one that occurred in the past and was successfully treated. Treponemal antibody tests include FTA-ABS, TP-PA, and MHA-TP. FTA-ABS (Fluorescent treponemal antibody absorption) test is used to diagnose neurosyphilis. However, TP-PA (T. pallidum particle agglutination assay) test is sometimes performed instead of FTA-ABS because it is more specific and there are fewer false positives. MHA-TP (Microhemagglutination assay) test, another confirmatory method, is used much less commonly now. Immunoassays (IA): in more recent years, several automated tests have been developed, making them convenient for screening purposes. 2. Direct detection of bacteria—These tests are less commonly used now. Dark field microscopy is used in the early stages of syphilis when a suspected syphilis sore (chancre) is present. It involves obtaining a scraping of the sore, placing it on a slide, and examining it with a special instrument called a dark-field microscope. 3. Molecular testing (polymerase chain reaction, PCR): This test detects genetic material from the bacteria in the sample from the sore, in blood, or in CSF.

False negative test results mean that RPR test is negative in the presence of syphilis infection. The body does not always produce antibodies specifically in response to the syphilis bacteria, so the test is not always accurate. False-negatives may occur in people with early- and late-stage syphilis. Hence, other tests are required to confirm the results.