Syphilis (RPR)

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RPR (Diagnosis) with Reflex to Titer and Confirmatory Testing


Clinical Significance

This is a non-treponemal screening test for syphilis. False positive results may occur due to systemic lupus erythematosus, leprosy, brucellosis, atypical pneumonia, typhus, yaws, pinta, or pregnancy. Monitoring of RPR is helpful in assessing effectiveness of therapy.


False-positive results have been associated in patients with infections, pregnancy, autoimmune disease, old age, Gaucher disease, and malignancy.

Alternative Name(s) 

Premarital RPR,Syphilis Serology Screen, Blood,ART,Rapid Plasma Reagin,Automated Reagin Test

RPR (Monitor) with Reflex to Titer 

Reference Range(s)

  • Non-Reactive

Clinical Significance

This is a non-treponemal screening test for syphilis. False positive results may occur due to systemic lupus erythematosus, leprosy, brucellosis, atypical pneumonia, typhus, yaws, pinta, or pregnancy. Monitoring of RPR is helpful in assessing effectiveness of therapy.


A positive RPR screen must be followed by a specific treponemal antibody test (e.g., FTA-ABS):

A positive result on the second method confirms the screening result and the affected person is diagnosed with syphilis.

A negative result on the treponemal test may mean that the initial RPR test was falsely positive. Further testing and investigation may be done to determine the cause of the false positive.


False-positive results have been associated in patients with infections, pregnancy, autoimmune disease, old age, Gaucher disease, and malignancy.

Alternative Name(s) 


Syphilis FTA-ABS (Confirmation for Syphilis RPR test)

FTA-ABS - Treponema pallidum Ab

Clinical Significance

The FTA-ABS is a specific treponemal assay to detect antibody to t. Pallidum. The FTA-ABS becomes reactive 4-6 weeks after infection. Unlike the nontreponemal tests, once the FTA-ABS test becomes reactive, it will remain reactive for many years. Since the reactivity found with the FTA-ABS does not indicate response to therapy, it is not suitable for monitoring treatment. The FTA-ABS test does not distinguish between syphillis and other treponematoses such as yaws, pinta and bejil.

The treponemal antibody test (FTA-ABS) is often used as an initial test. A positive result indicates the presence of syphilis antibodies in the blood, but since treponemal antibodies remain positive even after an infection has been treated, it does not indicate whether the person has a current infection or was infected in the past. Conversely, nontreponemal antibodies as detected with an RPR typically disappear in an adequately treated person after about 3 years. Thus, if an initial treponemal test is positive, an RPR can be performed to differentiate between an active or past infection. In this case, a positive RPR would confirm that the person has been exposed to syphilis and, if not treated previously, has an active infection or, if treatment had occurred more than 3 years ago, possible re-infection.

Alternative Name(s) 

Treponemal pallidum, Fluorescent Treponemal Antigen, Syphilis

Beta-2-Glycoprotein 1, apolipoprotein H, is a cofactor in antiphospholipid antibody binding and is the critical antigen in the antiphospholipid antibody syndrome. Beta-2-Glycoprotein 1 Antibody is more specific than cardiolipin antibody that may express reactivity in patients with syphilis and other infectious diseases.

Beta-2-Glycoprotein 1, apolipoprotein H, is a cofactor in antiphospholipid antibody binding and is the critical antigen in the antiphospholipid antibody syndrome. Beta-2-Glycoprotein 1 Antibody is more specific than cardiolipin antibody that may express reactivity in patients with syphilis and other infectious diseases.

Beta-2-Glycoprotein 1, apolipoprotein H, is a cofactor in antiphospholipid antibody binding and is the critical antigen in the antiphospholipid antibody syndrome. Beta-2-Glycoprotein 1 Antibody is more specific than cardiolipin antibody that may express reactivity in patients with syphilis and other infectious diseases.


  • CBC (includes Differential and Platelets)
  • Antibody Screen, RBC with Reflex to Identification, Titer, and Antigen Typing 
  • ABO Group and Rh Type
  • RPR (Diagnosis) with Reflex to Titer and Confirmatory Testing
  • Hepatitis B Surface Antigen with Reflex Confirmation*
  • Rubella Antibody (IgG), Immune Status
  • If Antibody Screen is positive, Antibody Identification, Titer, and Antigen Typing will be performed at an additional charge (CPT code(s): 86870, 86886, 86905).
  • If RPR screen is reactive, RPR Titer and FTA Confirmatory testing will be performed at an additional charge (CPT code(s): 86593, 86780).
  • If Hepatitis B Surface Antigen is positive, confirmatory testing based on the manufacturer's FDA approved recommendations will be performed at an additional charge (CPT code(s): 87341).

The major proteins seen in the serum are albumin and globulin-the latter being primarily alpha 1 and alpha 2 globulin, beta globulin and gamma globulin. Albumin accounts for more than 50% of the total serum proteins. The albumin to globulin (A/G) ratio has been used as an index of disease state, however, it is not a specific marker for disease because it does not indicate which specific proteins are altered. The normal A/G ratio is 0.8-2.0. The A/G ratio can be decreased in response to a low albumin or to elevated globulins. Total globulins may be increased in some chronic inflammatory diseases (TB, syphilis) multiple myeloma, collagen disease, and rheumatoid arthritis. Decreased levels are seen in hepatic dysfunction, renal disease and various neoplasms.

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Elevated RF is found in collagen vascular diseases such as SLE, rheumatoid arthritis, scleroderma, Sjögren's Syndrome, and in other conditions such as leprosy, tuberculosis, syphilis, malignancy, thyroid disease and in a significant percentage of otherwise normal elderly patients.

The Tissue Plasminogen Activator assay is used to detect disorders of the fibrinolytic system.

Clinical Significance
VDRL, Serum - The serum VDRL test is an aid in the diagnosis of syphilis. The predictive value of a reactive VDRL is increased when combined with a treponemal-specific test such as FTA or TP-PA. A reactive VDRL test on CSF, free of blood or other contaminants, usually suggests past or present syphilis infection of the central nervous system.

Syphilis is an unwanted intruder that has hung around the human species for several thousand years. It's a sexually transmitted infection that appears in different stages. If it's not treated early, the consequences can be life-threatening.

Syphilis tests are the key to early diagnosis, treatment, and recovery. But how can you avoid catching syphilis? Is it curable? How long will symptoms last?

Let's take a closer look at syphilis testing to answer these questions and more.

What Is Syphilis?

Syphilis is a sexually transmitted disease (STD). According to the Centers for Disease Control, it is common, and the infection rate has been increasing in recent years. The Treponema pallidum bacterium causes syphilis.

Syphilis is one of the infectious diseases that a pregnant woman can pass on to her unborn child, known as congenital syphilis.

Risk Factors for Syphilis

Syphilis is almost always spread through sexual contact. During sex, transmission occurs through coming in contact with an infected person's sore.

The most common ways of contracting syphilis are through:

  • Unprotected sex
  • Sex with multiple partners
  • Men who have sex with men
  • Already having an HIV infection

All forms of sexual activity can put you at risk of catching syphilis. Men who have sex with men are at the highest risk of catching syphilis.

Causes of Syphilis

Syphilis is a bacterial infection. When an uninfected person comes into contact with a chancre, an ulcer on the genitals, they can catch the disease. This typically happens through the mucus membranes or minor cuts on the body.

What Are the Signs and Symptoms of Syphilis?

Syphilis has four main stages if left untreated. It can be hard to diagnose syphilis without screening tests, as it can look like other diseases.

Primary Stage

Syphilis first shows itself with a single chancre - a small painless ulcer. This can appear on the penis, scrotum, vagina, anus, or mouth. This is highly contagious and even kissing can spread the disease at this stage. 

Although a single chancre is common, sufferers can get many sores. If untreated, it will develop into the secondary stage.

Secondary Stage

The secondary stage shows up with skin rashes and lesions in the mouth, vagina, or anus. The skin rashes can appear on any part of the body. They may be painless, but are rough and have a red appearance. 

Other symptoms include:

  • Headaches
  • Swollen glands
  • Lesions in the groin, mouth, or under the arms
  • Muscle aches
  • Weight loss

As with the primary stage, these symptoms will pass in time. But the body cannot cure itself of syphilis. If you do not get treatment, it will move into the latent or tertiary stage.

Latent Syphilis

Once the secondary stage is over, the syphilis infection may lie dormant for a period of time. This stage can last for years.

Tertiary Syphilis

Tertiary syphilis can occur many years after the initial infection. The bacteria now start to affect organ systems, such as the liver, heart, vascular system, or joints. It can also affect the brain and the nervous system.

At any stage in the infection, syphilis can turn into neurosyphilis or ocular syphilis. These forms affect the nervous system and eyes respectively.

How Is Syphilis Diagnosed?

Syphilis is diagnosed using three methods. First, a physical examination checking the outward symptoms of the disease.

Secondly, syphilis tests will be run. Positive results on a syphilis blood test will show whether you have an active infection or have had syphilis in the past. Finally, if you have a chancre, your doctor may take a sample of fluid for testing.

The Lab Tests to Screen, Diagnose, and Monitor Syphilis

The key screening test for syphilis is the RPR (Monitor) test. This looks for the presence of antibodies and can detect syphilis in people who have the disease. This can also be used for monitoring the disease and detecting reinfection in the future.

Another test that is often used in conjunction with RPR is the FTA-ABS #4112. This test is not suitable for monitoring the effectiveness of treatment. However, it can be useful for initial diagnosis.

Frequently Asked Questions About Syphilis and Lab Testing for Syphilis

There are lots of rumors and stories online about syphilis. The most frequently asked questions about syphilis and syphilis lab tests include:

  • What should you not do if you have syphilis?

If you have syphilis, you should avoid any activity that could pass it on to another person. This would include having unprotected sex. You should also avoid using recreational drugs.

  • Is syphilis 100% curable?

It is possible to rid the body of the bacteria that causes the syphilis infection. In this way, it is 100% curable. That said, the treatment to clear the infection will not reverse the damage the condition has already done.

  • How long does it take for syphilis to go away after treatment?

If syphilis is detected early, it can be treated with a single injection of penicillin. If your doctor suspects that you have more long-term syphilis, a longer and more potent course of treatment may be needed. You will need to have further syphilis tests to check whether the infection has been cured.

Get Answers Fast With Syphilis Tests from Ulta Lab Tests

The only accurate way to know if you have this disease is through syphilis tests. They are quick, with results coming back in 2-4 days. Syphilis lab tests can help you know what you're dealing with, so you can start the right treatment as soon as possible.

Benefits of Syphilis Lab Testing with Ulta Lab Tests

Ulta Lab Tests offers syphilis tests that are highly accurate and reliable so you can make informed decisions about your health. Here are a few great things to love about Ulta Lab Tests:

  • You'll get secure and confidential results
  • You don't need health insurance
  • You don't need a physician's referral
  • You'll get affordable pricing
  • We offer a 100% satisfaction guarantee

Order your syphilis lab tests today and your results will be provided to you securely and confidentially online in 24 to 48 hours for most tests.

Take control with Ulta Lab Tests today!

Syphilis is an STD (a sexually transmitted disease) that has the potential to cause severe health problems if it isn’t treated. 

Syphilis Defined

Syphilis is an infectious disease with potentially serious consequences if it remains untreated. Syphilis spreads through sexual contact. The disease is divided into stages: primary, secondary, latent, and tertiary. Different stages of syphilis have their own signs and symptoms, or lack thereof.

How Does Syphilis Spread?

Syphilis spreads through sexual contact. Syphilis sores appear on or near the penis, vagina, anus, and mouth. You can contract syphilis through any act of vaginal, oral, or anal sex if you make direct contact with a syphilis sore. A pregnant woman with syphilis can infect her unborn baby with the disease.

What Does Syphilis Look Like?

As mentioned above, syphilis is divided into stages, with each stage having different signs and symptoms. In the primary stage, an infected person will generally have one or more syphilis sores near their original infection site. The sores usually occur on or near the genitals, around the anus, in the rectum, or inside or close to the mouth. Most syphilis sores are free of pain, round, and firm to the touch. Symptoms of secondary stage syphilis include fever, swollen lymph nodes, and rashes on the skin. In the primary and secondary stages, the symptoms of syphilis can be mild and consequently overlooked. The latent stage of syphilis gets its name from its lack of symptoms. Tertiary syphilis involves more severe medical issues. In this stage, the disease can affect the brain, heart, and other organs. Doctors use a range of different tests to diagnose tertiary syphilis.

What Can I Do To Reduce My Risk Of Contracting Syphilis?

Abstaining from sexual contact is the only guaranteed way to avoid an STD like syphilis. There are ways to reduce your risk if you are sexually active:

* Restrict yourself to a monogamous relationship with a partner who has tested negative for syphilis.

* Use latex condoms properly in every sexual encounter. Condoms can protect you from syphilis by preventing contact with syphilis sores. Condoms are not a foolproof defense against syphilis because sex may involve intimate contact with areas not covered by a condom. Syphilis sores in these areas can still transmit the disease even if you use a condom.

What Is My Risk for Syphilis?

If you are sexually active, any unprotected sex (vaginal, anal, or oral) puts you at risk of contracting syphilis. Talk honestly about your sexual activity with your health care provider to find out whether or not you need testing for syphilis and other STDs.

A pregnant woman’s first prenatal visit should include a syphilis test.

Regular syphilis testing is important if you fall into the following risk groups:

* If you are a man who has sex with men,

* If you have HIV, or

* If a current or former sexual partner has tested positive for syphilis.

Why Is Syphilis A Concern For Pregnant Women?

If you are infected with syphilis and become pregnant, the infection may be passed to your child before it’s born. Syphilis can cause serious pregnancy complications, including low birth weight, premature delivery, or a stillborn birth (that is, a dead baby). Receiving at least one syphilis test during your pregnancy is a vitally important way to protect your child. If you test positive, you should seek immediate treatment. 

It is possible for a baby infected with syphilis to be born without showing any signs or symptoms. However, serious medical problems can develop within a few weeks of birth if syphilis is not treated immediately. Untreated syphilis in infants can cause cataracts, seizures, deafness, and even death.

What Are The Symptoms Of Syphilis?

As already discussed, adult syphilis occurs in stages, each of which has different signs and symptoms. Here is a more detailed breakdown:

* Primary Syphilis

At this stage of the disease, you may see one or more sores appear. Primary syphilis sores are found most often around the site of initial infection. These sores are usually round, firm, and free from pain. Because syphilis sores are typically painless, they are easy to overlook. Syphilis sores heal after approximately three to six weeks whether or not you receive treatment for the disease. Treatment is still essential even after the sores disappear; without treatment, the disease will progress to the next stage.

* Secondary Syphilis

In secondary syphilis, you may have skin rashes and/or mucous membrane lesions. These lesions are sores in the anus, vagina, or mouth. The secondary stage of syphilis usually begins with the appearance of a rash on one or more areas. This stage can start anytime from while your primary sores are still healing to several weeks after the sores have healed. Syphilis rashes can look like red or reddish-brown spots or rough patches of skin on the palms of your hands and/or the bottoms of your feet. Secondary syphilis rashes are not usually painful or itchy, and sometimes they are so faint that you may not notice them. Secondary syphilis may or may not also have these other symptoms: fever, headaches, swollen lymph glands, sore throat, weight loss, patchy hair loss, muscle pain, and fatigue (extreme tiredness). As with primary syphilis, your secondary syphilis symptoms will eventually go away with or without treatment. Treatment is vital to prevent further progression.

* Latent Syphilis

In the latent stage of syphilis, the disease does not have any signs or symptoms. Syphilis can stay in your body for years in the latent stage if you do not get treatment.

* Tertiary Syphilis

Not every syphilis infection proceeds to tertiary syphilis. When it does develop, tertiary syphilis can cause severe damage to the heart and circulatory system and the brain and nervous system. Tertiary syphilis usually begins 10 to 30 years after you were first infected. Tertiary syphilis damages your internal organs and can be fatal.

Neurosyphilis and Ocular Syphilis

When left untreated, syphilis can spread to the nervous system or the eyes. Neurosyphilis affects the nervous system, while the eyes are affected by ocular syphilis. These complications can occur during any stage of syphilis.

Neurosyphilis symptoms:

* Severe headaches,

* Paralysis (inability to move your body parts),

* Diminished muscle coordination,

* Numbness, and

* Dementia.

Ocular syphilis can include vision changes or blindness.

How Can I Find Out If I Have Syphilis?

A healthcare provider can generally diagnose syphilis with a simple blood test. In some instances, your doctor may diagnose syphilis by taking fluid from a sore and testing it.

Is Syphilis Curable?

Yes! Syphilis is curable with prescribed antibiotics from your healthcare provider. Note that syphilis treatment may not undo any damage that the disease caused before you get treated.

Can I Get Syphilis Again After I Have Been Treated?

Contracting syphilis does not give you any protection from getting the disease again, and you can be re-infected even after receiving successful treatment. Laboratory testing is the only sure way to determine whether or not you have syphilis. Your healthcare provider should order follow-up testing after treatment to confirm that the disease is gone.

Even though a sex partner has to have sores to infect you, these can easily be overlooked. Syphilis sores may appear inside the vagina, mouth, or anus, or under the foreskin of the penis. Unless you are certain that all of your sex partners have tested negative for syphilis, you are still at risk for getting it again.

To receive more STD information and STD clinic referrals, contact the CDC-INFO contact center:

1-800-CDC-INFO (1-800-232-4636)

TTY: (888) 232-6348

Content source: Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention