Newer Syphilis Reverse Algorithm The advent of newer, faster treponemal antibody tests have allowed high-throughput of sensitive and specific trep. tests as the first step in the algorithm. Newer Trep (+) (chemiluminescent/ ELISA trep antibody) Reflex to non-Trep. (VDRL or RPR) Non-trep tests look for patient antibodies that interact with cardiolipin, derived from ox hearts. This is a less specific marker of inflammation caused by syphilis but also other conditions. The titre is also quantitative and may be trended. For the small subset of patients with discordant trep and non-trep, the slower, more labor-intensive treponemal test (TPPA) can be performed. If (+) for new and old trep test, but (-) for anti- cardiolipin (ox heart), consider untreated chronic infection vs. previously treated infection vs. very early infection. #Syphilis #Reverse #Algorithm #Testing #Diagnosis
