Rpr titer chart.
Adapted from: Public Health Agency of Canada.
Rpr titer chart. 4. Obtain a patient specimen previously determined to be Non-reactive. The best approach would be to compare maternal and neonatal RPR titers collected at the same time, and where there is at least 4-fold higher titer seen in the neonate, it should significantly raise suspicion for congenital Mar 12, 2018 · 1:50 Diluent for RPR Quantitation Note: This procedure utilizes potentially infectious patient specimens. , RPR, VDRL), then, if reactive, follow with a treponemal test (e. pallidum IgG chemiluminescence immunoassay (CLIA) and the T. Patients with neurosyphilis without HIV infection or those with HIV infection who are on effective ART and who exhibit serologic (normalization of the serum RPR titer) and clinical responses after treatment do not need repeated CSF examinations. e. TREPONEMA POSITIVE: RPR testing is performed. Nontreponemal (RPR) kits allow labs to use the traditional screening method for syphilis testing, which indicates an active syphilis infection and monitors treatment. , from 1:16 to 1:4 or from 1:8 to 1:32), is considered necessary to demonstrate a clinically significant difference between two nontreponemal Special Instructions Two patient identifiers must be on all specimens (full name, date of birth, ID#, etc. The following information is required to interpret syphilis test results for the purpose of diagnosing and staging syphilis: Sexual history, symptoms and clinical signs AND Treponemal test result AND Rapid Plasma Reagin (RPR) test result AND Previous syphilis serology results (if available) AND History of treatment (if available). In interpreting serologies, it is helpful to know which testing algorithm (traditional vs reverse) is being used in your lab. Sep 27, 2022 · Again, with secondary syphilis and a person who has a really high RPR titer, let’s say, 1:2,048, that titer right at the time of diagnosis or right at the time you’re treating. Natasha Press June 24, 2020 An RPR is stable with at least 2 lab results at 1:4 or less (or RPR is non-reactive) If 4-fold increase, consider reinfection, contact public health For clients with HIV coinfection – contact HIV care provider or public health Adapted from: Public Health Agency of Canada 2021 Canadian Guidelines on Sexually Transmitted Infections Mar 25, 2022 · Syphilis is a common STD and it can cause a range of symptoms, so how is it diagnosed? STDWatch tells you how to read syphilis test results. Statistical analysis Cleveland Clinic Laboratories RPR antibodies shows faster clearance kinetics and usually disappears in 4–6 weeks postnatally, if only there is no congenital syphilis. Currently, cases of possible syphilis are commonly investigated using the treponemal serological tests T. Syphilis (Treponema pallidum) Serologic Testing Update – Changes to Screening Test and Algorithm. The rapid plasma reagin (RPR), a nontreponemal test, has traditionally been used as an initial screening test for syphilis because it is widely available, relatively easy to perform, and inexpensive (Medicare midpoint reimbursement, RPR with reflex titer, $8. com Dear Person, Syphilis Confirmatory: Rapid plasma reagin (RPR) - a semi-quantitative flocculation assay that detects non-treponemal antibodies to cardiolipin-lecithin- cholesterol (Reagin antibodies). 3 RPR titer dilutions and examples of fourfold (two dilutions) decreases in titer values. The box for each 2) Rapid Plasma Reagin (RPR) This is used for staging infection, following response to treatment and determining re-infection. ) The sequence below is the order the evacuated tubes must be filled to prevent specimen or additive cross contamination For specimen requirements including storage and transport temperatures, consult our Test Directory on our website – www. Nov 1, 2022 · Reading of RPR results was performed by at least 2 experienced laboratory technicians blinded to the initial RPR result. Types of Syphilis Tests There are two main categories of tests used to detect syphilis: Treponemal 1. The ASI Evolution® is a fully automated nontreponemal RPR syphilis analyzer. Results should be reported quantitatively. Labstract, LAB-SD-057-002 * Health Canada. Feb 14, 2020 · Response to treatment Nontreponemal (RPR/VDRL) titers can be used to monitor treatment response. We would like to show you a description here but the site won’t allow us. A fourfold change in titer (e. REACTIVE Question Answer 5. Screening values/titers for the traditional and reverse algorithms (RPR and syphilis IgG) were also compared with confirmation status. Recognize index values that indicate a weak positive versus a strong positive Syphilis Antibody interpretation. The antigen is prepared from a modified Venereal Disease Research Laboratory (VDRL) antigen suspension containing choline chloride to eliminate the need to heat-inactivate serum Use of a cut-off value from the rapid plasma reagin (RPR) titer has been proposed as an alternative to determine follow-up priority among patients with latent syphilis. pallidum). Successful treatment is associated with a 4-fold or two-tube decline in titer (ie, from 1:32 to 1:8) 6 months after therapy for primary or secondary syphilis and 1 year after therapy for latent syphilis. The subsequent increase in titer (from 1:8 to 1:64) likely suggests reinfection, and would require repeating treatment. In these situations, the titer range of the automated test must be considered, and specimens should require reflex testing using a manual RPR procedure to establish an endpoint titer at either the lower or upper bounds before reporting. Methods We retrospectively analyzed the clinical records of These titers should decline fourfold within six months after treatment of primary or secondary syphilis and within 12 to 24 months after treatment of latent or late syphilis. Learn syphilis testing and interpretation: What testing types are available? How accurate are syphilis tests? When and should you be tested for syphilis? ABSTRACT Syphilis is a multisystem infection caused by the spirochete Treponema pallidum. RPR 1:4 to 1:16), OR 3) history of negative serologic test for syphilis within past 12 months. Dec 12, 2022 · A rapid plasma reagin (RPR) test is a blood test used to screen you for syphilis. Does the patient have a history of symptoms consistent with primary or secondary syphilis during the last 12 months? Yes STOP. Detects total IgG/IgM antibody to syphilis (T. Manual RPR tests were interpreted negative for titers < 1 and positive for titers ≥ 1. Serological tests in HIV In addition, nontreponemal test titers might decrease more slowly for persons previously treated for syphilis (594, 595). High titer (RPR>1:32) syphilis that does not decline 2 titers (4-fold) over 6-12 months (1 o or 2 osyphilis) or 12-24 months (latent syphilis) But 10-20% of 1 o/2 owon’t have 4-fold decline <12 months Quantitative Test RPR - Rapid Plasma Reagin Test. ARUP Laboratory Tests Rapid Plasma Reagin (RPR) with Reflex to Titer 0050471 Method Semi-Quantitative Particle Agglutination Treponema pallidum Antibody by TP-PA 0050777 The blood-screening tests most often used to detect evidence of syphilis are the VDRL (Venereal Disease Research Laboratory) test and the RPR (rapid plasma reagin) test. Treponemal Passive Particle Agglutination Test ( TPPA) 5065 is ordered automatically with a positive RPR qualitative test. 5); 0. Syphilis Re-infection Because the antibodies detected in treponemal tests usually remain detectable for life, even after successful treatment, the non-treponemal titer (RPR or VDRL) must be used to monitor for a re-infection with syphilis. 25 indicated a 4-fold decline; and 0 indicated seroreversion. No follow-up necessary unless clinically indicated (eg, early syphilis). Only orderable as a reflex. Treponema pallidum particle agglutination (TP. Doctors recommend the RPR test when they suspect that a person may have a syphilis infection. Learn about RPR test or RPR test for syphilis. Matthew Clifford-Rashotte and Dr. g. This device would be suitable for RPR test is a macroscopic, nontreponemal flocculation card test used to screen for syphilis. Considered screening or monitoring tests. When ordering an RPR=rapid plasma reagin (non-treponemal) and results are positive, order a REFLEX treponemal test such as TP-PA=Treponema pallidum particle agglutination assay. The titer of antibody will vary from patient to patient There is no direct relationship between the amount of reagin and the severity of disease. Mar 13, 2020 · Blood Tube Color Chart Blood Tube Color Chart for specimens submitted to University of Colorado Hospital Laboratory The traditional algorithm uses a non-treponemal test (NTT) - typically a rapid plasma reagin (RPR) test - to screen sera, followed by one (1) or two (2) TTs on the positive samples. Syphilis Test Algorithm Revised 031919 The marker "RPR (Rapid Plasma Reagin) Titer" on a sexually transmitted disease (STD) test panel is an essential diagnostic tool in the assessment and management of syphilis, a bacterial infection caused by Treponema pallidum. Dec 24, 2024 · Abstract Introduction Although the rapid plasma reagin (RPR) test is used to determine treatment efficacy for syphilis, animal studies show that it decreases gradually after an initial increase even with-out treatment. Remember that the syphilis titers one follow over time to evaluate the response to treatment are the non-treponemal test titers, the RPR or VDRL. A weakly reactive result is a reportable result from VDRL and RPR. If the RPR is positive, then it is an active infection. How to interpret RPR test results, what does RPR test non reactive mean? What does positive RPR test mean? Jan 30, 2025 · A nontreponemal test (i. 11). RPR, quantitative 5040 The RPR titer allows for the correction interpretation of the syphilis test and the automatic addition of the confirmatory test. Decline in titers were represented as decimal values in the y-axis, in which 0. 4 However, the RPR Jul 25, 2023 · Traditionally, rapid plasma reagin (RPR) and venereal disease research laboratory (VDRL) tests are the non-treponemal serologic tests used to screen for active syphilis infection and monitor response to treatment. Centers for Disease Control and Prevention | CDC Supplementary Tables By Dr. Patients often find it difficult to recall their RPR titers. A titer of 1:32 or greater in the baby or a titer > 4 times greater than the mother's titer is very suggestive of fetal infection. In the latent stage and after successful treatment, the RPR may become nonreactive. An RPR or VDRL titer that is four or more times higher than the maternal titer is suggestive of congenital syphilis. cpllabs. For more information or any questions, please contact: Jun 7, 2014 · The RPR and VDRL are both qualitative and quantitative. Automatically done by lab if CMIA is reactive. Find out how Medical Health Authority can help you interpret your results and provide appropriate treatment. It has replaced the VDRL test due to having properties like no need of preparing fresh reagents daily, no need for a microscope, and also no need for heat inactivation of the serum sample. Ocular, otic, and neurologic involvement may occur during any stage of syphilis. Rapid Plasma Reagin (RPR) with Reflex to Titer RPRT Choose the Right Test ARUP Consult® assists with test selection and interpretation Screen with lipoidal antigen test (e. Objective: To compare syphilis titers to current syphilis stage definitions. Aug 21, 2024 · To properly interpret serologic test results, titers should be compared with the patient's prior post-treatment titer. *Criteria for Assignment: 1) No records of previous serology, OR 2) ≥4-fold titer increase (e. To screen for syphilis infection, a reflex cascade that includes both RPR and a treponema -specfic assay should be utilized, such as Treponema pallidum (Syphilis) Screening Cascade [082345] or Rapid Plasma Reagin (RPR) Test With Reflex to Quantitative RPR and Confirmatory Treponema pallidum Antibodies [012005]. Canadian Guidelines on Sexually Transmitted Infections; Public Health Laboratory (2017). In the secondary stage, the RPR should be reactive 100% of the time, decreasing to 90% in the tertiary stage. Positive results can Adapted from: Public Health Agency of Canada. Box plots of decrease in nontreponemal antibody titers based on baseline RPR titers and month (s) after therapy (x-axis). May be non-reactive or reactive, if reactive, should be diluted to establish titer. RPR titres change in response to treatment or disease progression. Refer to package insert for specific reporting language, for certain methods a 1:1 titer may be reported as minimally reactive in certain circumstances. For all syphilis-positive women detected during ANC, their newborns should be tested by RPR using infant serum and not cord blood as it can yield false-positive result All newborns showing fourfold rise in titer compared to that of their mothers' titer need to be hospitalized to initiate penicillin treatment for 10 days. Communicable Diseases, Syphilis. Canadian STD Guidelines. This can pose a challenge when they change providers and particularly if they move between states or countries. FDA cleared for diagnostic and blood donor screening and cadaveric (non-heart beating) donor screening. We frequently encounter questions about the interpretation of syphilis serology and about the appropriate treatment of various clinical stages of syphilis. Report as early latent syphilis (730) No (Go to #6) 6. 3 Additionally, RPR is a quantitative test and antibody titers can be monitored to assess treatment response. SUMMARY OF TEST PRINCIPLE AND CLINICAL RELEVANCE The rapid plasma reagin (RPR) 18-mm circle card test is a macroscopic, nontreponemal flocculation card test used to screen for syphilis (1–4). These antibodies may not be detected until six weeks after infection. Aug 2, 2016 · Comprehensive guide on syphilis treatment and monitoring, covering stages of disease, management strategies, and potential complications. Aug 7, 2022 · RPR is a screening non-specific test for syphilis caused by a bacterium, Treponema pallidum. PA) - a qualitative gelatin particle agglutination assay that confirms antibodies (IgG and IgM) to Treponema Syphilis Re-infection Because the antibodies detected in treponemal tests usually remain detectable for life, even after successful treatment, the non-treponemal titer (RPR or VDRL) must be used to monitor for a re-infection with syphilis. Flocculation/Agglutination Apr 26, 2017 · Serum rapid plasma reagin (RPR), Treponema pallidum particle agglutination (TPPA), and their parallel testing format for screening S-NS were evaluated. Case Conclusion Our patient’s RPR titer decreased fourfold following initial treatment (from 1:32 to 1:8), consistent with a successful response to treatment. Syphilis can be separated into four different stages: primary, secondary, early non-primary non-secondary, and unknown duration or late syphilis. Titers decline after proper treatment over a period of months to years. , Venereal Disease Research Laboratory [VDRL] or Rapid Plasma Reagin [RPR]) with positive or reactive results must have a quantitative titer result reported (e. RPR NEGATIVE: Specimen is sent out for TP-PA testing to ARUP RPR POSITIVE: If positive; RPR titer is performed May 19, 2025 · We examined the performance of the syphilis antibody component of a rapid multiplex device and found that sera with RPR titers of 1:8 and greater, often found in infectious syphilis, were highly likely to test positive. For more information see RPRT1 / Rapid Plasma Reagin (RPR) Screen with Reflex to Titer, Serum. The RPR test kit provides diagnostic and blood donor screening labs a budget friendly manual test for laboratories. Nontreponemal titers can increase immediately after treatment, presumably related to the treatment response. Jun 21, 2018 · The rapid plasma reagin test is a simple blood test that screens for syphilis. The likelihood of S-NS was positively associated with the serum RPR and TPPA titers. Unknown / Latent / Tertiary Quantitative nontreponemal serologic tests should be repeated at 6, 12, and 24 months in nonreactive HIV persons and compared with the titer at the time of treatment. RPR assay works on the principle of flocculation and flocculation is a special type of precipitation where Learn how to properly perform the ASI RPR test and interpret results with a video guide or visual step by step procedures. ASI’s RPR test screens for syphilis; a sexually transmitted infection caused by Treponema pallidum. During the past 12 months has the patient’s Nontreponemal titer increased fourfold (2 dils) or greater? Yes STOP. The ASI Evolution helps eliminate subjectivity, improves workflow, reduce labor costs, and minimize false-positive results. pallidum particle agglutination (TPPA). The treponemal test titers (TPPA* or FTA-ABS*) once reactive usually remain reactive for the life of the patient. NONREACTIVE Rapid Plasma Reagin Screen with Reflex to Titer, Serum No serologic evidence of syphilis. [28, 43] To make a new laboratory diagnosis of syphilis in a person previously diagnosed with syphilis, the nontreponemal test titer must be at least 4-fold higher than the Syphilis Test Algorithm Revised 031919 Syphilis Unlikely* *Primary syphilis and late, untreated syphilis are possible if RPR/VDRL are non-reactive—see below for recommended actions. Titers may be atypical if a patient had prior syphilis infections, has taken incidental treatment, has a history of substance use, or is living with HIV. . Persons who have signs or symptoms that persist or recur and those with at least a fourfold increase in nontreponemal test titer persisting for >2 weeks likely were reinfected or experienced treatment failure. e. Identify the causes of false positive and false negative syphilis test results. If possible, titers should be compared using the same test methodology since the rapid plasma reagin (RPR) and the Venereal Disease Research Laboratory (VDRL) may differ from one another. Clinical Workflow Algorithm: screening Syphilis Screening This document translates screening guidance and clinical considerations from the USPSTF and CDC into a decision tree format to guide implementation. An alternative approach is to use a reverse sequence algorithm, which uses a TT to screen and a quantitative NTT to confirm the positives. Nontreponemal test titers usually decrease after treatment and might become nonreactive with time. com/interpretation-of-syphilis-serology/ Feb 6, 2024 · In these situations, the titer range of the automated test must be considered, and specimens should require reflex testing using a manual RPR procedure to establish an endpoint titer at either the lower or upper bounds before reporting. , EIA, CIA, TP-PA). For more information or any questions, please contact: Determine the expected timing for the onset of detectable Treponemal and Nontreponemal antibody (RPR). The titer of the specimen was expressed as the reciprocal of the highest dilution showing an agglutination of the carbon particles. No treatment indicated * Scenario 4 – in which an infant at delivery has a normal physical exam and titer < 4-fold mother’s titer, AND the mother was adequately treated prior to becoming pregnant and sustains RPR titers <1:4 or VDRL<1:2 throughout pregnancy – is not included. Titer values are measured through non-treponemal tests such as RPR, VDRL, and USR. Note that the titers derived from the RPR or VDRL tests are not interchangeable. Gloves, eye protection, and protective clothing are required. Estimated turn around time for test result is 24 -48 hours. Sep 28, 2023 · Introduction Although the rapid plasma reagin (RPR) test is used to determine treatment efficacy for syphilis, animal studies show that it decreases gradually after an initial increase even without treatment. A fourfold change in titer, equivalent to a change of two dilutions (e. A presumptive diagnosis is possible with sequential serologic tests (e. Jan 6, 2025 · RPR, Serum (Syphilis Serology) rapid plasma reagin nontreponemal Inoculation Point NOTE: Titers cannot be used as the sole factor for determining disease stage, source/spread, or duration of infection. Inoculation Point NOTE: Titers cannot be used as the sole factor for determining disease stage, source/spread, or duration of infection. VDRL, RPR), using the same testing method each time. 10, 17 Congenital syphilis is associated with a high rate of stillbirth, and The traditional syphilis testing algorithm begins with the RPR (nontreponemal) test with positive samples reflexing to RPR titer and treponemal antibody testing. January 2010 Edition. See Step #3 of the California Syphilis Reactor Processing Algorithm. A titer is a measure of the amount of antibody formed in response to syphilis. Pre-treatment changes in RPR titer in humans and its relationship with post-treatment changes in RPR titer are not well known. Apr 29, 2012 · I have read a number of responses about syphilis testing and results, but I am totally unclear about what the titer results mean. The quantitative dilution titers are reported with positive tests. 5 indicated a 2-fold decline in titers (eg, 1:16 at one month divided by baseline titer of 1:32, or 16/32 = 0. 2. Syphilis Reverse Test Algorithm Syphilis TP Antibody (SYPH) Reactive/Equivocal Non-Reactive RPR Reactive with past or c Non-Reactive Chart review included prior documented history of syphilis, prior treatment for syphilis, and treatment following results. An RPR is stable with at least 2 lab results at 1:4 or less (or RPR is non-reactive) If 4-fold increase, consider reinfection, contact public health If penicillin allergy – refer to allergist for penicillin sensitivity test If anaphylactic penicillin allergy contact public health for alternative options Feb 3, 2022 · Inform her that since her RPR titer decreased by at least four-fold she was effectively treated. Dear Person, - pathgroup. Lipoidal antigen tests detect IgM and IgG antibodies directed against lipoidal antigens released due to cell damage from the host and bacteria. Used to confirm a positive rapid tests The RPR will determine if the positive rapid result indicates a current active infection or an earlier infection, and the baseline titre allows the response to treatment to be Sep 25, 2018 · "Nontreponemal test antibody titers might correlate with disease activity and are used to follow treatment response. Jan 4, 2025 · Rapid Plasma Reagin Screen ensures accurate test results for syphilis diagnosis, utilizing blood tests and laboratory analysis to detect antibodies, providing reliable diagnostic outcomes and informing treatment options for patients. nontreponemal test titer during laboratory results that meet the likely the previous 12 months (and or verified criteria for neurologic, no evidence that increase was ocular, otic, and/or late clinical no not sustained for >2 weeks)? manifestations of syphilis? Sep 7, 2023 · Fig. However, a fourfold increase in titer after treatment (e. The traditional algorithm starts with a non-treponemal test (RPR or VDRL) which, if reactive, is followed by a confirmatory treponemal test (TPPA). , 1:4) and documented on the Form I-693 at Part 8, Civil Surgeon Worksheet, Section 1B. Is 1:2 low or high? Is 1:16 better or worse than 1:8? Mar 26, 2025 · What Is Syphilis Titer? Syphilis titer is an important indicator in syphilis testing, used to determine the level of antibodies in a patient’s blood to monitor disease progression or treatment effectiveness. The nontreponemal rapid plasma reagin (RPR) flocculation test is used to assess disease activity The traditional algorithm starts with a non-treponemal test (RPR or VDRL) which, if reactive, is followed by a confirmatory treponemal test (TPPA). com The reverse algorithm (Syphilis Screen w/rflx RPR and Titer or TPPA) begins with a treponemal specific antibody test, reactive results are confirmed with an RPR screen. The RPR test is a non-treponemal serological test that quantitatively measures the concentration of reagin antibodies in the blood. It is a non treponemal test, and measures antibody against cardiolipin, providing a crude indicator of disease activity. RPR test measures IgM and IgG antibodies to lipoidal material. Ideally, the same type of nontreponemal test (RPR or VDRL) is used when comparing current titers with prior titers, since methods used with the RPR and VDRL are different. , from 1:8 to 1:32) that is sustained for >2 weeks is concerning for reinfection or treatment failure. An increase in titer of two dilutions represents re-infection with Treponema pallidum. It works by detecting the nonspecific antibodies that your body produces while fighting the infection. The serum TPPA titers performed better than the serum RPR titers in screening S-NS. Jan 16, 2024 · VDRL and RPR are equally valid assays; however, quantitative results from the two tests cannot be compared directly with each other because the methods are different, and RPR titers frequently are slightly higher than VDRL titers. If the RPR is negative, then a secondary treponemal test (TP-PA) is employed. Ask the lab to perform definitive testing with dark field microscopy to determine if she still has active disease. INTERPRETATION OF SYPHILIS SEROLOGY: SUPPLEMENTARY TABLES http://thischangedmypractice. from 1:8 to 1:32) is usually considered to be clinically significant. These antibodies are produced as an Learn about RPR titer 1:1, its significance, and what it means for your health. Non-specific (or non-treponemal) tests Done in a laboratory. ykubeszphrziqcsrncglyutnpzzywcgtskxvpcsluogfhuw