Reverse Sequence Syphilis Testing: Pros and Cons of Syphilis Screening with EIA

Syphilis testing has always been confusing because the tests, by themselves, don’t identify infected patients.  Now, some labs have reversed the traditional screening sequence, starting with automated treponemal tests to reduce lab costs.  In areas where syphilis has been prevalent, the lab savings can be overwhelmed by the cost of managing persons who have positive treponemal tests and negative nontreponemal tests (who previously would be undetected).  Current recommendations are to treat them if they have no history of syphilis treatment, but tertiary syphilis is quite rare, so perhaps treatment is unnecessary when nontreponemal tests are negative.