1/12/22, 9:41 PM Syphilis screening for asymptomatic, nonpregnant adults - UpToDate

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Syphilis screening for asymptomatic, nonpregnant adults

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1/12/22, 9:41 PM Syphilis screening for asymptomatic, nonpregnant adults - UpToDate

This algorithm addresses syphilis screening in asymptomatic, nonpregnant adults. It does not apply to patients who present with or develop symptoms consistent with
syphilis. Refer to the UpToDate topic on screening and diagnostic testing for syphilis for a discussion of testing in patients with clinical signs and symptoms suggestive of
infection.

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1/12/22, 9:41 PM Syphilis screening for asymptomatic, nonpregnant adults - UpToDate

* Nontreponemal tests include the rapid plasma reagin (RPR), the Venereal Disease Research Laboratory (VDRL), and the toluidine red unheated serum test (TRUST).

¶ Treponemal tests include the fluorescent treponemal antibody absorption (FTA-ABS), the treponema pallidum particle agglutination (TPPA), the T. pallidum enzyme
immunoassay (TP-EIA), or chemiluminescence immunoassay (CIA). These different tests target different antigens.

Δ Both treponemal and nontreponemal tests take time to convert (eg, approximately 2 to 4 weeks ) in the setting of a new infection. Thus, on rare occasion, asymptomatic
patients who have had a recent exposure to syphilis may have a false-negative nontreponemal or treponemal screening test.

◊ Treatment of syphilis depends upon the clinical manifestations and the stage of disease (eg, early, late, neurosyphilis). Asymptomatic patients are considered to have
latent syphilis and should be treated for early latent (the patient was infected within the last 12 months) or late latent disease (the patient was infected more than 12
months ago). Refer to the UpToDate topics that discuss clinical manifestations, treatment, and monitoring of syphilis for specific information.

§ False-positive nontreponemal tests can be seen in the setting of pregnancy, an acute event (eg, febrile illness, endocarditis, Rickettsial disease), or recent immunization.
Test abnormalities attributed to these conditions are usually transitory and typically last for six months or less. Other etiologies include chronic conditions, such as
autoimmune disorders (particularly systemic lupus erythematosus), intravenous drug use, chronic liver disease, and underlying HIV disease.

¥ Refer to UpToDate topic on treatment and monitoring of syphilis to help guide management decisions.

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