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Test ID RPRT1 Rapid Plasma Reagin (RPR) Screen with Reflex to Titer, Serum


Ordering Guidance


This test is for monitoring response to therapy in patients treated for syphilis infection. This test should not be used as a primary diagnostic approach for syphilis. To screen for undiagnosed syphilis infection, order SYPH1 / Syphilis IgG with Reflex, Enzyme Immunoassay, Serum



Specimen Required


Collection Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Collection Instructions: Centrifuge and aliquot serum into a plastic vial.

Specimen Volume: 0.5 mL


Useful For

Determining the current disease status

 

Monitoring response to therapy for syphilis

 

Aid to diagnose congenital syphilis

 

This test cannot be used for testing spinal fluid specimens.

 

This test is not intended for medical-legal use.

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
RPRT2 RPR Titer,S No No

Testing Algorithm

If this test is positive, then the rapid plasma reagin titer will be performed at an additional charge.

Method Name

Flocculation/Agglutination

Reporting Name

RPR Screen w/ Reflex to Titer,S

Specimen Type

Serum

Specimen Minimum Volume

0.4 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 14 days
  Frozen  14 days

Clinical Information

Syphilis is caused by infection with the spirochete Treponema pallidum subspecies pallidum. The infection is systemic, and the disease is characterized by periods of latency. These features, together with the fact that T pallidum cannot be isolated in culture, mean that serologic techniques play a major role in the diagnosis and follow-up of treatment for syphilis.

 

Historically, the serologic testing algorithm for syphilis included an initial nontreponemal screening test, such as the rapid plasma reagin (RPR) or the VDRL tests. Because these tests measure the host's immune response to nontreponemal antigens, they lack specificity. Therefore, a positive result by RPR or VDRL requires confirmation by a treponemal-specific test, such as the fluorescent treponemal antibody-absorption (FTA-ABS) or microhemagglutination (MHA-TP) assay. Although the FTA-ABS and MHA-TP assays are technically simple to perform, they are labor intensive and require subjective interpretation by testing personnel.

 

As an alternative to the traditional syphilis screening algorithm, many laboratories utilize the reverse syphilis screening algorithm. This algorithm starts with an automated treponemal assay to detect antibodies specific to T pallidum. If this screening assay is positive, the sample is reflexed for testing by RPR, which, if positive, is reported with a titer and is indicative of active or recent syphilis infection. If the RPR is negative, the sample is reflexed to a second treponemal assay, such as the T pallidum particle agglutination (TP-PA) assay. If the TP-PA is positive, this would indicate previously treated or late-stage syphilis infection. Alternatively, if the TP-PA is negative, the initial positive screen is interpreted as a false positive result.

 

Patients with primary or secondary syphilis are typically tested by RPR to monitor response to treatment. Typically, RPR titers decrease following successful treatment, but this may occur over a period of months to years. Additionally, testing of maternal and neonate serum, collected concurrently, by RPR can be used as an aid to diagnose congenital syphilis.

Reference Values

Negative

Reference values apply to all ages.

Interpretation

Negative:

Nontreponemal antibodies not detected.

Positive:

Specimen reflexed to determine rapid plasma reagin titer.

Clinical Reference

1. Centers for Disease Control and Prevention (CDC): Discordant results from reverse sequence syphilis screening-five laboratories, United States, 2006-2010. MMWR Morb Mortal Wkly Rep. 2011 Feb;60(5):133-137

2. Radolf JD, Tramont EC, Salazar JC: Syphilis (Treponema pallidum). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Elsevier; 2020:2865-2892

3. Binnicker MJ, Jespersen DJ, Rollins LO: Direct comparison of the traditional and reverse syphilis screening algorithms in a population with a low prevalence of syphilis. J Clin Microbiol. 2012: Jan;50(1):148-150

Day(s) Performed

Monday through Saturday

Report Available

Same day/1 to 4 days

Test Classification

This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

86592

86593-Rapid Plasma Reagin Titer (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
RPRT1 RPR Screen w/ Reflex to Titer,S 20507-0

 

Result ID Test Result Name Result LOINC Value
616863 RPR Screen w/ Reflex to Titer,S 20507-0

Forms

If not ordering electronically, complete, print, and send a Microbiology Test Request (T244) with the specimen.