Changing Algorithms in Syphilis Laboratory Diagnosis

Syphilis is a highly infectious sexually transmitted disease that is easily curable if detected in the early stages. Syphilis re-emerged as a public health threat in 2001, and case rates have steadily increased, primarily among men who have sex with men (MSM). The appropriate use of highly sensitive and specific laboratory diagnostic tests is critical in efforts to reduce the incidence of syphilis. In January 2009, the Association of Public Health Laboratories and the Centers for Disease Control and Prevention convened an expert consultation to evaluate available information and produce recommendations for the development of guidelines for the laboratory diagnosis of Treponema pallidum infections in the United States. This article discusses the current state of laboratory diagnostics and the challenges faced in using serologic assays for the diagnosis of syphilis.