Guidance

Results table and reporting comments for syphilis

Updated 25 May 2022

Applies to England

The table below shows different testing results. For each set of results, clinical comments for reports and recommendations for the laboratory team are outlined below the table.

Result	Treponemal test 1 EIA/CLIA	Treponemal test 2 EIA/CLIA/TPHA/TPLA	RPR
1	Negative	Not required	Not required
2	Low-level or equivocal reactivity	Low-level or equivocal reactivity in 2nd EIA/CLIA	Negative
3	Low level or equivocal reactivity (repeat sample)	Low level or equivocal reactivity in 2nd EIA/CLIA	Negative
4	Positive or equivocal	Positive	Negative: titre ≤ 1:16
5	Positive or equivocal	Positive	Positive: titre > 1:16
6	Positive or equivocal	Negative	Negative
7	Positive or equivocal (repeat sample)	Negative	Negative
8	Positive or equivocal	Negative	Positive
9	Positive or equivocal (repeat sample)	Negative	Positive

Result 1

For this result the clinical comments to report are:

• treponemal antibody not detected
• no evidence of treponemal infection
• repeat if at risk of recent infection

When screening tests for all 3 infections are negative add the following comments:

• negative at time the screening sample was taken
• please offer testing at any time in pregnancy if the woman has a new exposure risk or develops relevant symptoms

Result 2

Repeat both EIA/CLIA tests on current sample. If the results are reproduced, then report as follows:

• Result may be due to non-specific cross-reactivity or due to treponemal infection
• Please send a further sample in two weeks to exclude early syphilis

Result 3

If both EIA/CLIA tests give the same results on repeat sample, the clinical comments to report are:

• persistent low reactivity in treponemal tests may be non-specific or due to treponemal infection
• refer to a sexual health specialist immediately for clinical assessment

Result 4

For this result, the clinical comments to report are:

• treponemal antibody detected
• results consistent with treponemal infection at some time
• refer to a sexual health specialist for clinical assessment

Result 5

For this result, the clinical comments to report are:

• treponemal antibody detected
• results consistent with recent or active treponemal infection
• refer to a sexual health specialist for clinical assessment

Result 6

Repeat EIA/CLIA on current sample. If the result is reproduced, then report as follows:

• screening result not confirmed in further tests and is probably non-specific but early infection must be considered
• please repeat 2 weeks from the date of this sample to clarify results and exclude early syphilis

Result 7

If the EIA/CLIA gives the same results on repeat sample, then report as follows:

• results unchanged from previous sample
• discrepant results due to false positive screening test
• no action required

Result 8

This is an unusual pattern of results. Repeat all tests on current sample. If the results are reproduced, then report as follows:

• inconclusive results
• to clarify please repeat 2 weeks from the date of this sample

Result 9

If the repeat sample produces the same results send both samples to the reference laboratory and delay reporting until the reference laboratory report is received.