Syphilis testing and treatment NYC, New York
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AT A GLANCE

WHO SHOULD GET TESTED FOR SYPHILIS?

People who have symptoms suggesting syphilis and people who are at high risk of contracting syphilis, even if they don’t have symptoms, should be tested.

Patients with symptoms of syphilis

The symptoms of syphilis are similar to those of many other skin conditions, and it is important that syphilis, when present, be diagnosed, so the threshold for syphilis testing is very low.

Syphilis testing is offered to everyone who has these symptoms, regardless of whether they are high risk or low risk for contracting it:

A sore on the genitals, which could indicate primary syphilis
A rash on the palms, soles of the feet, or elsewhere on the body

Patients without symptoms of syphilis

Again, it’s important to diagnose and treat syphilis, so testing is offered to those who are at high risk of contracting this sexually transmitted infection, even if they have no symptoms of syphilis.
According to the CDC, high-risk people generally include the following persons:

Those engaging in unprotected sex with multiple sexual partners
Those diagnosed with HIV
Those with a recent diagnosis of any sexually transmitted disease
Those who are having a sexual contact with someone who has been diagnosed with syphilis
Men who have sex with men

WHEN TO GET TESTED FOR SYPHILIS?

Different types of syphilis tests should be done at different times:

RPR: 2–3 weeks after exposure
VDRL: 3–6 weeks after exposure
FTA-ABS: 3–4 weeks after exposure
TPPA: 3-4 weeks after exposure

SYPHILIS TEST TYPES

This table indicates how soon after risky sexual contact that is believed to have exposed the patient to syphilis each test can be done and how accurate it is at that time.

Syphilis test types	The earliest the syphilis test can be done —— Syphilis test accuracy
RPR	2–3 weeks after exposure Accuracy: 86%
VDRL	3–6 weeks after exposure Accuracy: 78%
FTA-ABS	3–4 weeks after exposure Accuracy: 84%
TPPA	3–4 weeks after exposure Accuracy: 88%

SYPHILIS TEST PREPARATION

No preparation for a syphilis test is required.

Frequently Asked Questions

What is the best screening test for syphilis?
Two types of tests are common for initial screening for syphilis:
- RPR (rapid plasma reagin)
- VDRL (Venereal Disease Research Laboratory)
These tests are not specific for syphilis. For this reason, they are called nontreponemal tests (the bacterium that causes syphilis is Treponema pallidum). If the results come back positive, they should be confirmed with a different type of test.
How are syphilis tests done?

All syphilis tests are blood tests.
How long do the syphilis test results take to come back?

If the syphilis test is negative, the results will be available in three business days because only one part of the test (RPR) must be done. If that part of the syphilis test is positive, it might take seven business days for the results to come back because a second, confirmatory, test must be done.

What do the syphilis test results mean?

Interpreting syphilis test results is more complex with syphilis than with other sexually transmitted infections. A positive syphilis test can mean several things, including newly contracted syphilis or previously treated syphilis.

RPR and VDRL are nontreponemal tests, meaning they are not specific for syphilis
FTA-ABS, TPPA, EIA, and CLIA are all treponemal tests, meaning tests specific to the syphilis bacterium, Treponema pallidum

EIA, CLIA	RPR	VDRL	FTA-ABS	TPPA	Syphilis Test Interpretation
	+		+	+	This pattern of syphilis test results can mean any of these three things: If testing was for diagnosis and the patient has no history of syphilis The results are positive for syphilis. If testing was for diagnosis and the patient has a history of syphilis The results are considered positive if the titer (number) in nontreponemal test (RPR) results is four times higher than the previous test titer. If testing was after syphilis treatment When a follow-up test is positive, the patient’s health care provider should review the previous results and the report, especially changes in the RPR titer.
		+	+	+	This pattern of syphilis test results can mean any of these three things: If testing was for diagnosis and the patient has no history of syphilis The results are positive for syphilis. If testing was for diagnosis and the patient has a history of syphilis The results are considered positive if the titer (number) in nontreponemal test (VDRL) results is four times higher than the previous test titer. If testing was after syphilis treatment When a follow-up test is positive, the patient’s health care provider should review the previous results, especially changes in the VDRL titer.
+	-			+	This pattern of syphilis test results can mean either of two things: For low-risk people (most people) The results are interpreted as negative—that is, there is no evidence of infection. For high-risk people (homosexual males, people having unprotected sex or sex with multiple sexual partners, etc.) A retest should be done.
+	-			+	This pattern of syphilis test results can mean any of these three things: For people with no history of syphilis The patient probably has syphilis (e.g., early or latent). For people with a history of syphilis The results merely reflect that the person has had syphilis that’s been treated.

Positive nontreponemal test with positive treponemal test

A positive nontreponemal test (RPR or VDRL) combined with positive treponemal tests (FTA-ABS and TPPA) means, of course, that the overall syphilis testing is positive. This does not necessarily mean that the person tested has syphilis.

Whether the person has a history of syphilis is important and must be considered along with the test results.

No history of syphilis

The results are interpreted as the patient now having syphilis.

A history of syphilis that has been treated

If the titer (number) on the nontreponemal test (RPR) is negative, the results are interpreted as negative.
If the RPR titer number stays low positive after treatment (which is referred to as being in a serofast state), the results are considered negative.
If the titer (number) on the nontreponemal test is four times higher than the post-treatment number, the results are considered positive.

Positive nontreponemal test with negative treponemal

A positive nontreponemal test (RPR and VDRL) combined with a negative treponemal (confirmatory) test (FTA-ABS or TPPA) means that the nontreponemal result was a false positive (since the positive result wasn’t confirmed by the treponemal test).

About 1% to 2% of people tested for syphilis in the United States have false-positive results. (Importantly, false-positive results have a low RPR titer (number).

False-positive syphilis test results are most common in certain patients: those who are pregnant; those who have lupus, HIV, or endocarditis; and those who have recently been immunized.

If retested in about six months, a syphilis test that had been a false positive is usually back to normal (i.e., negative).

Positive treponemal test with negative nontreponemal test

A positive treponemal test (FTA-ABS or TPPA) combined with a negative nontreponemal test (RPR and VDRL) can indicate either of two things:

The patient has had syphilis in the past that was successfully treated (the past treatment must be verified or at least recalled by the patient).
The patient may have syphilis now and further testing is necessary to make this determination.

Where is testing for syphilis done?

Syphilis testing can be done in primary care offices, urgent care clinics, gynecology clinics, planned parenthood clinics, community health centers, free STD centers, and our STD specialized walk-in clinic. .

How can I protect my partner from getting syphilis?

Syphilis transmission

Syphilis transmission requires skin-to-skin contact (mainly during the genital or oral sex). When any area of skin with microscopic damage comes in contact with a syphilis sore or a mucous patch containing syphilis infection in a high concentration, T. pallidum, the syphilis bacteria, can gain access to the subcutaneous (under-the-skin) tissue and cause infection.

The truth about common syphilis myths

It’s not true that if you’ve had syphilis before, you can’t get it again. Unfortunately, your immune system doesn’t develop long-term protection against syphilis
It’s not true that syphilis can be spread only by someone who has syphilis symptoms
It’s not true that syphilis can be passed only through ejaculation

	Sex (per unprotected intercourse)	Sex toys	Hard surfaces (toilet seats, doorknobs, etc.)	Textiles (clothing, towels, and bedding)
Chance of syphilis transmission	Male to female: 10%–30% Female to male: 10%–30%	Possible,* but no data are available so the risk is unknown *Fresh fluids containing syphilis bacteria would have to be on the toy. Toys that are dry (either unclean or cleaned with soap) are usually safe.	Very unlikely* (close to 0%) *The chance is only theoretical. A series of events that’s very unlikely would have to happen for transmission to occur.	Very unlikely* (close to 0%) * The chance is only theoretical. A series of events that’s very unlikely would have to happen for transmission to occur.

How to protect your partner

Since syphilis is transmitted through skin-to-skin contact, you can avoid spreading it to your sex partner by following these precautions:

Don’t allow the infected part of your body make contact with your partner’s skin or mucosa while you have symptoms
Don’t let your partner touch the infected area
Don’t share sex toys
If you touch your infected area, wash your hands with soap before touching your partner

Important: You should notify everyone you’ve had sex with in the last 60 days about your syphilis diagnosis. Suggest that they have a medical examination and testing. This will prevent further syphilis transmission and possible health complications to them, you, and/or other partners.

Is syphilis testing covered by health insurance?
Yes. Commercially available syphilis tests are covered by health insurance.

If you want to be certain that your insurance plan covers it, call your insurance company and ask for this information:
- 1. The lab they prefer (you will want to use a testing lab (such as Quest, Labcorp, or Northwell) that has a pricing arrangement with your health plan)
- 2. Whether the test you want done is covered—if you are asked for ICD and CPT codes, give them these codes:
  - ICD B00.9
  - CPT 86695 or 86696
- 3. Whether you will be responsible for paying any amount for the test (that is, whether a deductible or coinsurance applies)
What does syphilis testing cost if I don’t have health insurance?

Without health insurance, the office visit costs $84 cash (or $90 credit), and the syphilis testing (in a certified lab) costs $50.
Where is the STDcenterNY clinic located?

Our walk-in sexual health clinic is conveniently located on the east side of Midtown Manhattan near the Grand Central Terminal and the Main branch of the New York City public library.
Despite it being our only STD testing center, we offer STI testing and related health services to New Yorkers from all zip codes across all 5 NYC boroughs: the Bronx, Manhattan, Brooklyn, Queens, and Staten Island.
Our certified STD clinic offers testing services for syphilis and other common STDs (including gonorrhea, herpes, chlamydia, HPV (genital warts), HIV (also rapid HIV testing), hepatitis B, and hepatitis C), along with quality medical care and follow-up checkups.