RPR (Diagnosis) with Reflex to Titer and Confirmatory Testing

The RPR (Diagnosis) with Reflex to Titer and Confirmatory Testing test contains 1 test with 1 biomarker.

Brief Description: The rapid plasma reagin test is used to determine if a person has been infected with syphilis. An RPR can be used to monitor treatment for syphilis and the effectiveness of syphilis treatment. Syphilis testing is a two-part test. The first round of testing for syphilis is an RPR test. If these results come back positive, a second round of testing will be required. A positive RPR result will be followed by a second method that will be used to confirm the results. If the second syphilis test comes back positive, the affected person will be diagnosed with syphilis. If the second test comes back negative, it could mean that the first test is a false positive and more testing may be necessary.

Also Known As: Rapid Plasma Reagin with Reflex to Titer, Syphilis RPR, Syphilis Titer test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

IMPORTANT: If RPR screen is Reactive, then RPR Titer and Chemiluminescence - Treponemal Antibody Immunoassay for Confirmatory testing will be performed at an additional charge

When is an RPR test ordered?

When a person shows signs and symptoms of syphilis, a syphilis test may be done.

Regardless of symptoms, a person should be tested for syphilis if they:

• Are being treated for gonorrhea or another sexually transmitted disease?
• If a woman is pregnant, she should be seen during the first prenatal visit, then again in the third trimester and at the time of delivery if she is at high risk.
• Are a man who has sex with other males; testing should be done at least once a year or every 3-6 months if the risk is significant.
• Engages in high-risk sexual behavior, such as having intercourse with several partners without protection.
• If you have HIV, you should get tested when you're initially diagnosed and then at least once a year after that; if you're at high risk, you should get tested more frequently.
• Has one or more partners who have tested positive for syphilis
• Officials from the Department of Public Health have told him or her that he or she has been exposed to an infected partner.

When a person has been treated for syphilis, the CDC recommends doing follow-up testing, such as assessing antibody levels, to ensure that the therapy was successful and the infection was cured.

What does an RPR blood test check for?

Syphilis is a bacterial illness caused by Treponema pallidum that is communicated mostly through sexual intercourse, such as direct touch with a syphilis sore, a firm, elevated, painless sore. Antibodies generated in response to a T. pallidum infection are detected in the blood by the most standard syphilis tests. Some less popular techniques directly identify the bacterium or its genetic components.

Syphilis is easily treated with medications, but if left untreated, it can cause serious health concerns. A mother who is afflicted can convey the disease to her unborn child, which can have serious and even fatal effects for the newborn.

With syphilis, there are numerous stages that can occur:

• The primary stage of syphilis begins about 2-3 weeks following infection. One or more chancres emerge, usually on the body portion exposed to the chancre of the sexual partner, such as the penis or vaginal area. The chancre, on the other hand, is usually painless and may go unnoticed, especially if it is in the rectum or on the cervix, and it goes away within 4-6 weeks, mending whether or not the infected person is treated.
• If primary syphilis is left untreated, secondary syphilis can develop anywhere from 6 weeks to 6 months after the chancre initially emerges. It is characterized by a rough, red, and speckled skin rash that appears regularly on the palms of the hands and the bottoms of the feet and does not itch. Fever, weariness, enlarged lymph nodes, sore throat, and body aches are some of the other symptoms that can occur.
• Secondary syphilis can progress to a latent stage, during which an infected individual has no symptoms but still retains the infection, and this stage can remain for years if left untreated. If left untreated, roughly 15% of persons will develop late, or tertiary, syphilis issues. Bacteria can harm the heart, eyes, brain, neurological system, bones, joints, and practically any other component of the body in these situations. Neurosyphilis is a disease that affects the central nervous system. Tertiary syphilis can linger for years, leading to mental illness, blindness, other neurological issues, heart disease, and death in the ultimate stage.
• If left untreated, syphilis progresses.

The basic and secondary stages of syphilis are the most contagious. About a third of the approximately 63,000 new cases of syphilis reported to the CDC in 2014 were main or secondary stage syphilis. Eighty-three percent of these cases included guys having intercourse with other men.

Antibiotics, usually penicillin, can be used to cure syphilis. Infections that have been acquired recently can be rapidly healed; however, someone who has been infected for more than a year may require prolonged therapy.

Lab tests often ordered with an RPR test:

When an RPR test is ordered, it's often part of a broader evaluation for sexually transmitted infections (STIs) and related health concerns. Here are some tests commonly ordered alongside it:

1. FTA-ABS Test:

   • Purpose: To confirm a syphilis diagnosis. These are specific treponemal tests that detect antibodies to Treponema pallidum.
   • Why Is It Ordered: To confirm a positive RPR result, as non-treponemal tests like RPR can sometimes give false-positive results.

2. Hepatitis B and Hepatitis C Tests:

   • Purpose: To screen for hepatitis B and hepatitis C viruses.
   • Why Is It Ordered: To assess for co-infection, as sexual transmission is a common route for these viruses as well.

3. Chlamydia and Gonorrhea Testing:

   • Purpose: To test for chlamydia and gonorrhea, common bacterial STIs.
   • Why Is It Ordered: These infections often occur together with syphilis, so it's important to screen for multiple STIs.

4. Herpes Simplex Virus (HSV) Types 1 and 2 Serology:

   • Purpose: To test for past or present infection with herpes simplex virus.
   • Why Is It Ordered: To evaluate for other STIs, especially if the patient has symptoms like genital ulcers.

5. Complete Blood Count (CBC):

   • Purpose: To evaluate overall blood health.
   • Why Is It Ordered: To check for signs of infection or anemia, which can occur with chronic diseases including STIs.

6. Liver Function Test:

   • Purpose: To assess liver health.
   • Why Is It Ordered: To evaluate liver function, as syphilis in its later stages can affect multiple organs, including the liver.

7. Urinalysis:

   • Purpose: To analyze various components of the urine.
   • Why Is It Ordered: To check for urinary tract infections or kidney involvement, especially in later stages of syphilis.

These tests, when ordered alongside an RPR test, provide a comprehensive assessment of sexual health and help in the diagnosis and management of sexually transmitted infections. They are crucial for identifying co-infections, assessing the impact of these infections, and guiding appropriate treatment strategies. The specific combination of tests will depend on the individual’s symptoms, sexual history, and risk factors.

Conditions where an RPR test is recommended:

The RPR with Reflex to Titer and Confirmatory Testing is ordered when there is suspicion of a syphilis infection or to screen for the infection in individuals at risk.

How does my health care provider use an RPR test?

Syphilis tests are used to detect and/or diagnose infection with the bacterium Treponema pallidum, which causes syphilis.

There are a variety of tests to choose from. The most common type of test is an antibody test.

Antibody tests identify antibodies in the blood and, occasionally, in the cerebrospinal fluid. Nontreponemal antibody test and treponemal antibody test are the two types of syphilis tests available. Syphilis screening can be done with any type, but it must be followed by a second test that employs a different approach to confirm a positive result and identify active syphilis:

Antibodies that aren't specifically directed towards the Treponema pallidum bacterium are detected by nontreponemal antibody testing. The body produces these antibodies when a person has syphilis, but they can also be produced in a variety of other situations. Because the tests are non-specific, false-positive findings can be produced by things like IV drug usage, pregnancy, Lyme disease, certain types of pneumonia, malaria, tuberculosis, or certain autoimmune disorders like lupus. A positive screening result must be double-checked with a more detailed test. Nontreponemal testing include the following:

RPR—in addition to screening, this test can be used to track syphilis therapy. Antibody levels are tested for this reason. When an initial test for treponemal antibodies is positive, it can also be used to confirm the existence of an active infection.

VDRL—in addition to blood, this test is largely used to identify neurosyphilis in the CSF.

Antibodies to T. pallidum are detected by treponemal antibody tests, which are blood tests. Because they are extremely specific for syphilis, they are unlikely to produce a positive result in other diseases. Once a person is infected and these antibodies form, they remain in the bloodstream for the rest of their lives. Nontreponemal antibodies, on the other hand, usually vanish within 3 years in a properly treated person. As a result, a positive treponemal screening result must be followed by a nontreponemal test in order to distinguish between an active infection and one that has been successfully treated in the past. FTA-ABS is a treponemal antibody test that is beneficial after the first 3-4 weeks after exposure. It can be used to assess antibodies to T. pallidum in the CSF to assist diagnose neurosyphilis in addition to blood testing.

TP-PA—instead of FTA-ABS, this test is sometimes used because it is more specific and has less false positives.

Another confirmatory approach is MHA-TP, which is presently used considerably less frequently.

Immunoassays—Several automated tests have been developed in recent years, making them useful for screening applications.

What do my Syphilis test results mean?

A negative blood test indicates that there is most likely no infection. A negative screening test, on the other hand, simply states that there was no evidence of disease at the time of the test. Antibodies may not be detected for several weeks following bacterial contact. If a person is aware that he or she has been exposed, or if the risk of infection remains high, additional testing may be required. It is also critical for persons who are at a higher risk of contracting syphilis to get regular screening tests to check for infection.

A particular treponemal antibody test must be performed after a positive RPR or VDRL screen:

The infected person is diagnosed with syphilis once a positive result on the second method confirms the screening result.

A negative treponemal test result could indicate that the initial RPR or VDRL test was incorrectly positive. To discover the reason of the false positive, more testing and investigation may be conducted.

A treponemal antibody test, on the other hand, will be used as an initial test by a healthcare practitioner or laboratory. A positive result indicates the presence of syphilis antibodies in the blood, but because treponemal antibodies stay positive even after an infection is treated, it does not indicate whether the person is now afflicted or has previously been infected. Nontreponemal antibodies found with an RPR, on the other hand, usually vanish after 3 years in a properly treated person. If the initial treponemal test is positive, an RPR can be used to determine whether the infection is active or past. A positive RPR in this scenario would establish that the person has been exposed to syphilis and, if not previously treated, has an ongoing infection or, if treatment occurred more than 3 years ago, possible re-infection.

The results of one or more RPR titers may be used to monitor treatment and/or determine if treatment was successful. Antibodies to syphilis should be decreased after therapy. If the RPR was 1:256 before therapy, a number of 1:16 after treatment would indicate a reduced amount of antibody. The affected person may have a persistent infection or was reinfected if the titer stays the same or rises. The results can also be transformed to a whole number or reported as dilutions.

Nontreponemal antibodies fade away over time after effective treatment, whereas treponemal antibodies remain in the blood for the rest of one's life.

Most Common Questions About the RPR with Reflex to Titer and Confirmation test:

Understanding the RPR with Reflex to Titer and Confirmatory Testing

What is the RPR with Reflex to Titer and Confirmatory Testing test?

The Rapid Plasma Reagin (RPR) with Reflex to Titer and Confirmatory Testing is a diagnostic test used to screen for syphilis, a sexually transmitted infection caused by the bacterium Treponema pallidum. If the initial RPR test is positive, a titer is then performed to measure the amount of antibodies in the blood. A confirmatory test (FTA-ABS or TP-PA) is also conducted to rule out the possibility of a false positive result.

When is the RPR with Reflex to Titer and Confirmatory Testing typically ordered?

This test is often ordered when a patient presents with symptoms of syphilis or has been exposed to a sexual partner with syphilis. It may also be conducted as part of routine screening for sexually active individuals or during pregnancy.

What do the results of the RPR with Reflex to Titer and Confirmatory Testing test mean?

A negative result suggests that the person does not have a current syphilis infection. However, if the infection is very recent, the RPR test might not detect it. A positive result needs to be confirmed by another test because the RPR test can sometimes give false-positive results.

Interpreting RPR with Reflex to Titer and Confirmatory Test Results

What does a positive RPR with Reflex to Titer and Confirmatory Testing result mean?

A positive result means that the patient's blood contains antibodies to the bacterium that causes syphilis. However, because the RPR test can yield false positives, a positive result is typically confirmed with another test like FTA-ABS or TP-PA.

What does a negative RPR with Reflex to Titer and Confirmatory Testing result mean?

A negative result generally suggests that the individual does not have a current syphilis infection. However, the test may not detect the infection if it's very recent, before the body has had time to produce antibodies.

RPR with Reflex to Titer and Confirmatory Testing and Specific Health Conditions

How is the RPR with Reflex to Titer and Confirmatory Testing used in the diagnosis of syphilis?

This testing approach is commonly used to diagnose syphilis. If the RPR test is positive, a titer is performed to quantify the amount of antibodies present. A higher titer indicates a more active or recent infection. A confirmatory test, like the FTA-ABS or TP-PA, is then done to ensure the RPR result was not a false positive.

Can the RPR with Reflex to Titer and Confirmatory Testing differentiate between various stages of syphilis?

RPR testing can help determine the activity of the syphilis infection. Increased titers generally suggest a more active infection, often correlating with earlier stages of the disease. However, RPR cannot definitively differentiate between the stages of syphilis.

RPR with Reflex to Titer and Confirmatory Testing and Treatment Considerations

How do the results of the RPR with Reflex to Titer and Confirmatory Testing influence the treatment plan?

Positive results lead to treatment with antibiotics, typically penicillin. The titers from the RPR test are used to monitor the effectiveness of treatment over time. The titer levels should decrease after effective treatment.

Can the RPR with Reflex to Titer and Confirmatory Testing be used to monitor the effectiveness of treatment for syphilis?

Yes, the RPR test can be used to track treatment progress for syphilis. Successful treatment usually results in lower RPR titer levels over time.

RPR with Reflex to Titer and Confirmatory Testing and Other Diagnostic Tools

How does the RPR with Reflex to Titer and Confirmatory Testing relate to other tests for syphilis?

The RPR test is commonly used as an initial screening for syphilis because it's simple and inexpensive. If the RPR is positive, a more specific test, such as the FTA-ABS or TP-PA, is performed to confirm the diagnosis.

Patient Considerations

Can lifestyle changes impact the RPR with Reflex to Titer and Confirmatory Testing results?

While lifestyle changes can't directly influence the results, practices such as consistent use of condoms and regular screening can reduce the risk of acquiring syphilis and other sexually transmitted infections.

What factors can influence the RPR with Reflex to Titer and Confirmatory Testing results?

The main factor is the presence or absence of antibodies against T. pallidum. However, the test may yield a false negative in very early syphilis (before antibodies have formed) or in late stages of the disease. Other conditions can also cause false positives.

Understanding Advancements and Limitations

What are the benefits of using the RPR with Reflex to Titer and Confirmatory Testing over other diagnostic methods?

RPR is less expensive and quicker than many other syphilis tests, making it a good choice for initial screening. The reflex testing helps confirm the diagnosis and gives a sense of the activity level of the infection.

Can the RPR with Reflex to Titer and Confirmatory Testing distinguish between syphilis and other sexually transmitted infections?

The RPR test is not specific for syphilis and can yield false positives due to other conditions. The confirmatory tests (FTA-ABS or TP-PA) that follow a positive RPR result are specific for syphilis and help confirm the diagnosis.

Why is there a need for confirmatory testing after the RPR test in the RPR with Reflex to Titer and Confirmatory Testing?

RPR is a non-treponemal test, which means it can yield false positives due to other medical conditions. The confirmatory testing is a treponemal test, which is specific for syphilis. Thus, it helps confirm whether a positive RPR result is truly due to syphilis.

What makes the RPR with Reflex to Titer and Confirmatory Testing a valuable tool in syphilis detection?

This testing strategy is valuable because it combines the speed and cost-effectiveness of RPR with the specificity of a confirmatory treponemal test, providing a comprehensive assessment of a patient's syphilis status.

What conditions might lead to a false-positive result on the RPR with Reflex to Titer and Confirmatory Testing?

Several conditions can lead to false-positive RPR results, including pregnancy, IV drug use, tuberculosis, malaria, lupus, Lyme disease, and HIV infection.

Can the RPR with Reflex to Titer and Confirmatory Testing provide insights into the patient's response to treatment?

Yes, by monitoring the titer levels over time, healthcare providers can get an idea of whether the treatment is working. Titer levels should decrease after effective treatment.

How does the RPR with Reflex to Titer and Confirmatory Testing contribute to the overall understanding of syphilis and its transmission?

The use of this test allows for early detection and treatment of syphilis, helping to prevent complications and reduce the spread of the infection. It also provides valuable epidemiological data on the prevalence and distribution of syphilis.

Can the RPR with Reflex to Titer and Confirmatory Testing be used to differentiate between treated and untreated syphilis?

RPR titers typically decrease after effective treatment, so monitoring these levels over time can help determine whether a person's syphilis infection is new or previously treated. However, some people may continue to have low-level titers even after successful treatment.

Can the RPR with Reflex to Titer and Confirmatory Testing detect syphilis in its latent (inactive) stage?

Yes, the RPR test can detect antibodies to syphilis even during the latent stage of the disease, although false negatives are more likely in the late latent stage.

How does the RPR with Reflex to Titer and Confirmatory Testing relate to the overall management of syphilis?

This testing approach is central to diagnosing, treating, and monitoring syphilis. Early detection leads to prompt treatment, which can prevent complications and transmission.

Are there other tests that may be preferred over the RPR with Reflex to Titer and Confirmatory Testing for certain patient populations or situations?

In some scenarios, the use of treponemal tests, such as the FTA-ABS or TP-PA, as the initial test may be preferred, such as in settings with a high prevalence of syphilis where false positives are less likely.

Are there factors that can cause a false-negative result on the RPR with Reflex to Titer and Confirmatory Testing?

Yes, in the very early stages of syphilis (the window period) or in late syphilis, the RPR test might not detect the infection. In the window period, the body has not yet produced antibodies to the bacterium, and in late syphilis, antibody levels may have decreased.

Is it possible to have a positive RPR with Reflex to Titer and Confirmatory Testing result even after successful treatment for syphilis?

Yes, some individuals may have a "serofast" reaction, where low levels of antibodies persist even after successful treatment. This does not indicate ongoing infection, and retreatment is not typically recommended.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.