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Blood sample positive with syphilis

Syphilis Testing: Everything You Need to Know

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Syphilis Testing

Syphilis is a sexually transmitted disease (STD) caused by a bacterial infection. It is important to detect and diagnose syphilis early to prevent further complications and the spread of the infection. Syphilis testing play a crucial role in screening, diagnosing, and monitoring the infection. In this comprehensive guide, we will explore everything you need to know about syphilis tests, including their purpose, types, when to get tested, how to get tested, and understanding test results.

What are Syphilis Tests?

Syphilis tests are essential tools used to screen for and diagnose syphilis, a common sexually transmitted disease caused by a bacterial infection. The infection can spread through vaginal, oral, or anal sexual contact with an infected person. It can also be transmitted from a pregnant person to their baby. Syphilis develops in stages, each with different signs and symptoms. In the early stages, the infection may be mild and go unnoticed, making testing crucial for early detection and treatment.

Purpose of the Test

Syphilis tests serve three primary purposes: diagnostic testing, screening, and monitoring. Diagnostic testing is recommended if you have signs or symptoms that could be caused by syphilis. It typically involves two tests: an initial screening test and a confirmatory test. Screening tests are used to detect the infection in individuals without symptoms, especially those at high risk of contracting or transmitting syphilis. Monitoring tests are conducted after treatment to ensure the effectiveness of the prescribed treatment and to track any changes in symptoms.

Types of Syphilis Tests

Syphilis tests detect specific antibodies in the blood produced by the immune system in response to the bacteria that cause syphilis. There are two main types of syphilis tests: nontreponemal antibody tests and treponemal antibody tests.

Nontreponemal Antibody Tests

Nontreponemal antibody tests detect antibodies that are not specific to the Treponema pallidum bacteria responsible for syphilis. While these antibodies are typically produced in response to syphilis infection, they can also be produced in response to other conditions. Nontreponemal antibody tests are often used as initial screening tests and require confirmation with another type of test. Common nontreponemal antibody tests include:

  • Rapid Plasma Reagin (RPR) Test: This test detects the reagin antibody, which is often produced in response to syphilis infection.
  • Venereal Disease Research Laboratory (VDRL) Test: VDRL measures antibodies produced within one to two weeks after the development of an initial sore in an infected person. It can be performed on blood or spinal fluid.

Treponemal Antibody Tests

Treponemal antibody tests detect antibodies produced specifically in response to the bacteria that cause syphilis. These antibodies are detectable earlier than nontreponemal antibodies and can persist indefinitely, even after successful treatment. Treponemal antibody tests cannot distinguish between current and past syphilis infections. These tests are often used to confirm a syphilis diagnosis after a positive nontreponemal test result. Examples of treponemal antibody tests include:

  • Fluorescent Treponemal Antibody Absorption (FTA-ABS) Test
  • Treponema Pallidum Particle Agglutination Assay (TP-PA) Test

Less common methods for detecting syphilis include darkfield microscopy, which uses a specially designed microscope to visualize Treponema pallidum bacteria, and polymerase chain reaction (PCR) testing, which detects the genetic material of the bacteria.

When Should I Get a Syphilis Test?

The timing and frequency of syphilis testing depend on various factors, including your risk of infection and transmission. Adults without symptoms should consider screening if they are at an increased risk of contracting syphilis or transmitting it to others. High-risk individuals include those involved in commercial sex work, living in areas with high syphilis infection rates, or males under the age of 29.

Additional groups that benefit from regular screening include pregnant individuals, sexually active men, transgender and gender-diverse individuals, and people diagnosed with HIV. Pregnant individuals should be tested at their first prenatal visit, at 28 weeks, and again at delivery if at high risk. Men and individuals with a penis who are sexually active should be tested annually, with more frequent testing if additional risk factors are present. Transgender and gender-diverse individuals should also undergo annual screening based on their sexual behaviors and risk of exposure.

Finding a Syphilis Test

Syphilis testing is typically ordered by a healthcare professional, and various settings offer testing, including hospitals, doctor’s offices, clinics, and community health programs. Additionally, at-home test kits are available for individuals seeking to test for syphilis from the comfort and privacy of their own homes. These kits provide the necessary materials to collect a blood sample and mail it to a laboratory for analysis. However, positive results obtained from at-home test kits require confirmation testing ordered by a doctor.

The cost of syphilis testing may be covered by health insurance when ordered by a healthcare professional. It is advisable to consult with your health insurance provider to understand specific costs, including copays and deductibles. In cases where testing is not covered by insurance, out-of-pocket costs may include the test itself, exam fees, technician fees, and additional tests performed simultaneously. Local health departments and community-based organizations often provide low-cost or free STD testing services for those concerned about the cost of syphilis testing.

Taking a Syphilis Test

Syphilis testing typically involves collecting a blood sample, although fluid from a syphilis sore or spinal fluid may also be used in certain cases. Blood samples are usually collected from a vein in the elbow or hand. The area is cleaned, and an elastic band is applied to increase blood flow. A needle is then inserted into the vein to collect the blood sample. After collection, pressure is applied to the site, and a bandage is provided to control bleeding.

Fluid from a syphilis sore is collected using a swab or brush, while spinal fluid is obtained through a procedure called a lumbar puncture. During a lumbar puncture, you will be instructed to lie on your side, and a healthcare provider will clean the area on your back before injecting a local anesthetic to reduce pain. A thin needle is then inserted into your spine to withdraw a small sample of cerebrospinal fluid for testing.

After the test, you may be advised to apply pressure to the injection site and given a bandage to prevent further bleeding. Risks associated with blood collection and sample collection from a sore are minimal. Following a lumbar puncture, you may be instructed to remain lying down for a period to prevent headaches, and temporary pain or tenderness at the insertion site is common.

Syphilis Test Results

Syphilis test results are usually available within hours to several days, depending on the type of test performed. You may receive your test results over the phone, during a follow-up appointment with your doctor, or through an electronic medical record system.

Interpreting test results depends on the type of test used. Nontreponemal test results may be reported as positive (reactive) or negative (non-reactive), with positive results indicating a potential syphilis infection that requires confirmation with a treponemal test. Treponemal test results are typically reported as reactive or nonreactive. A reactive result suggests a past syphilis infection, while a nonreactive result indicates no detectable antibodies and a low likelihood of infection.

It is crucial to discuss test results with a healthcare professional who can provide further guidance and interpretation. If you receive positive test results, your doctor can help determine the next steps, including additional testing or treatment. Regular testing for syphilis and other STDs is essential to maintain sexual health and prevent the spread of infections.

Cost of Syphilis Testing

The cost of syphilis testing can vary depending on factors such as insurance coverage, location, and the specific tests performed. When ordered by a doctor, the cost of testing may be covered by health insurance. It is advisable to consult with your insurance provider to understand any applicable costs, including copays and deductibles.

For individuals without insurance coverage, out-of-pocket costs may include the test itself, exam fees, technician fees, and additional tests performed concurrently. If cost is a concern, it is recommended to reach out to local health departments or community-based organizations that offer low-cost or free STD testing services. These resources can help ensure access to necessary testing without financial burden.

To initiate the process, it is advisable to commence by scheduling a visit to an for the purpose of undergoing a comprehensive test.


Syphilis testing plays a vital role in the early detection, diagnosis, and monitoring of syphilis infections. Through various types of tests, healthcare professionals can identify the presence of syphilis antibodies and confirm the diagnosis. Regular screening is crucial for individuals at risk of contracting or transmitting syphilis, including pregnant individuals, sexually active individuals, and those diagnosed with HIV.

Finding a syphilis test can be done through healthcare professionals, medical facilities, or at-home test kits. It is essential to consider the cost of testing, insurance coverage, and available resources to access affordable testing options. Understanding and interpreting syphilis test results is best done in consultation with a healthcare professional who can provide guidance tailored to individual circumstances.

By prioritizing regular testing and seeking appropriate medical care, individuals can take proactive steps to maintain their sexual health and prevent the spread of syphilis and other STDs.

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