{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T09:05:09Z","timestamp":1770800709669,"version":"3.50.0"},"reference-count":38,"publisher":"Archives of Pathology and Laboratory Medicine","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,1]]},"abstract":"\n Context.\u2014<\/jats:bold>\n Syphilis serology screening in laboratory practice is evolving. Traditionally, the syphilis screening algorithm begins with a nontreponemal immunoassay, which is manually performed by a laboratory technologist. In contrast, the reverse algorithm begins with a treponemal immunoassay, which can be automated. The Centers for Disease Control and Prevention has recognized both approaches, but little is known about the current state of laboratory practice, which could impact test utilization and interpretation.\n <\/jats:p>\n \n Objective.\u2014<\/jats:bold>\n To assess the current state of laboratory practice for syphilis serologic screening.\n <\/jats:p>\n \n Design.\u2014<\/jats:bold>\n In August 2015, a voluntary questionnaire was sent to the 2360 laboratories that subscribe to the College of American Pathologists syphilis serology proficiency survey.\n <\/jats:p>\n \n Results.\u2014<\/jats:bold>\n Of the laboratories surveyed, 98% (2316 of 2360) returned the questionnaire, and about 83% (1911 of 2316) responded to at least some questions. Twenty-eight percent (378 of 1364) reported revision of their syphilis screening algorithm within the past 2 years, and 9% (170 of 1905) of laboratories anticipated changing their screening algorithm in the coming year. Sixty-three percent (1205 of 1911) reported using the traditional algorithm, 16% (304 of 1911) reported using the reverse algorithm, and 2.5% (47 of 1911) reported using both algorithms, whereas 9% (169 of 1911) reported not performing a reflex confirmation test. Of those performing the reverse algorithm, 74% (282 of 380) implemented a new testing platform when introducing the new algorithm.\n <\/jats:p>\n \n Conclusion.\u2014<\/jats:bold>\n The majority of laboratories still perform the traditional algorithm, but a significant minority have implemented the reverse-screening algorithm. Although the nontreponemal immunologic response typically wanes after cure and becomes undetectable, treponemal immunoassays typically remain positive for life, and it is important for laboratorians and clinicians to consider these assay differences when implementing, using, and interpreting serologic syphilis screening algorithms.\n <\/jats:p>","DOI":"10.5858\/2016-0110-cp","type":"journal-article","created":{"date-parts":[[2016,10,20]],"date-time":"2016-10-20T13:16:38Z","timestamp":1476969398000},"page":"93-97","source":"Crossref","is-referenced-by-count":27,"title":["Prevalence of Traditional and Reverse-Algorithm Syphilis Screening in Laboratory Practice: A Survey of Participants in the College of American Pathologists Syphilis Serology Proficiency Testing Program"],"prefix":"10.5858","volume":"141","author":[{"given":"Daniel D.","family":"Rhoads","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan R.","family":"Genzen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine P.","family":"Bashleben","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James D.","family":"Faix","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. Qasim","family":"Ansari","sequence":"additional","affiliation":[{"name":"From the Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio (Drs Rhoads and Ansari); the Department of Pathology, University of Utah, Salt Lake City (Dr Genzen); the Department of Surveys, College of American Pathologists, Northfield, Illinois (Ms Bashleben); and the Department of Pathology, Montefiore Medical Center, Bronx, New York (Dr Faix)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3906","reference":[{"issue":"2","key":"i1543-2165-141-1-93-b01","series-title":"Clin Vaccine Immunol","first-page":"137","article-title":"Recent trends in the serologic diagnosis of syphilis","volume":"22","author":"Morshed \n MG,","year":"2015","unstructured":"Morshed \n MG, \n \n \n Singh \n AE. \n \n \n Recent trends in the serologic diagnosis of syphilis. Clin Vaccine Immunol. 2015;22(2):137\u2013147."},{"issue":"10","key":"i1543-2165-141-1-93-b02","series-title":"Eur J Clin Microbiol Infect Dis","first-page":"705","article-title":"Comparative evaluation of 15 serological assays for the detection of syphilis infection","volume":"26","author":"Cole \n MJ,","year":"2007","unstructured":"Cole \n MJ, \n \n \n Perry \n KR, \n \n \n Parry \n JV. \n \n \n Comparative evaluation of 15 serological assays for the detection of syphilis infection. Eur J Clin Microbiol Infect Dis. 2007;26(10):705\u2013713."},{"issue":"4","key":"i1543-2165-141-1-93-b03","series-title":"J Clin Microbiol","first-page":"1313","article-title":"Treponema-specific tests for serodiagnosis of syphilis: comparative evaluation of seven assays","volume":"49","author":"Binnicker \n MJ,","year":"2011","unstructured":"Binnicker \n MJ, \n \n \n Jespersen \n DJ, \n \n \n Rollins \n LO. \n \n \n Treponema-specific tests for serodiagnosis of syphilis: comparative evaluation of seven assays. J Clin Microbiol. 2011;49(4):1313\u20131317."},{"issue":"1","key":"i1543-2165-141-1-93-b04","series-title":"Clin Microbiol Rev","first-page":"1","article-title":"Laboratory diagnosis and interpretation of tests for syphilis","volume":"8","author":"Larsen \n SA,","year":"1995","unstructured":"Larsen \n SA, \n \n \n Steiner \n BM, \n \n \n Rudolph \n AH. \n \n \n Laboratory diagnosis and interpretation of tests for syphilis. Clin Microbiol Rev. 1995;8(1):1\u201321."},{"key":"i1543-2165-141-1-93-b05","series-title":"MMWR Morb Mortal Wkly Rep","article-title":"Syphilis testing algorithms using treponemal tests for initial screening\u2014four laboratories, New York City, 2005\u20132006","unstructured":"Centers for Disease Control and Prevention (CDC). Syphilis testing algorithms using treponemal tests for initial screening\u2014four laboratories, New York City, 2005\u20132006. MMWR Morb Mortal Wkly Rep. 2008:57(32);872\u2013875. http:\/\/www.cdc.gov\/mmwr\/PDF\/wk\/mm5732.pdf. Accessed February 22, 2016."},{"issue":"1","key":"i1543-2165-141-1-93-b06","series-title":"J Clin Lab Anal","first-page":"1","article-title":"Laboratory diagnosis of syphilis with automated immunoassays","volume":"23","author":"Marangoni \n A,","year":"2009","unstructured":"Marangoni \n A, \n \n \n Moroni \n A, \n \n \n Accardo \n S, \n \n \n Cevenini \n R. \n \n \n Laboratory diagnosis of syphilis with automated immunoassays. J Clin Lab Anal. 2009;23(1):1\u20136."},{"issue":"7","key":"i1543-2165-141-1-93-b07","series-title":"Clin Vaccine Immunol","first-page":"1084","article-title":"Evaluation of the BioPlex 2200 syphilis system as a first-line method of reverse-sequence screening for syphilis diagnosis","volume":"20","author":"Marangoni \n A,","year":"2013","unstructured":"Marangoni \n A, \n \n \n Nardini \n P, \n \n \n Foschi \n C, \n \n et al. \n Evaluation of the BioPlex 2200 syphilis system as a first-line method of reverse-sequence screening for syphilis diagnosis. Clin Vaccine Immunol. 2013;20(7):1084\u20131088."},{"issue":"1","key":"i1543-2165-141-1-93-b08","series-title":"J Clin Microbiol","first-page":"148","article-title":"Direct comparison of the traditional and reverse syphilis screening algorithms in a population with a low prevalence of syphilis","volume":"50","author":"Binnicker \n MJ,","year":"2012","unstructured":"Binnicker \n MJ, \n \n \n Jespersen \n DJ, \n \n \n Rollins \n LO. \n \n \n Direct comparison of the traditional and reverse syphilis screening algorithms in a population with a low prevalence of syphilis. J Clin Microbiol. 2012;50(1):148\u2013150."},{"issue":"6","key":"i1543-2165-141-1-93-b09","series-title":"Clin Infect Dis","first-page":"700","article-title":"Novel Treponema pallidum serologic tests: a paradigm shift in syphilis screening for the 21st century","volume":"51","author":"Sena \n AC,","year":"2010","unstructured":"Sena \n AC, \n \n \n White \n BL, \n \n \n Sparling \n PF. \n \n \n Novel Treponema pallidum serologic tests: a paradigm shift in syphilis screening for the 21st century. Clin Infect Dis. 2010;51(6):700\u2013708."},{"issue":"1","key":"i1543-2165-141-1-93-b10","series-title":"J Clin Microbiol","first-page":"2","article-title":"It is time to use treponema-specific antibody screening tests for diagnosis of syphilis","volume":"50","author":"Loeffelholz \n MJ,","year":"2012","unstructured":"Loeffelholz \n MJ, \n \n \n Binnicker \n MJ. \n \n \n It is time to use treponema-specific antibody screening tests for diagnosis of syphilis. J Clin Microbiol. 2012;50(1):2\u20136."},{"issue":"1","key":"i1543-2165-141-1-93-b11","series-title":"Sex Transm Dis","first-page":"1","article-title":"Serologic testing for syphilis in the United States: a cost-effectiveness analysis of two screening algorithms","volume":"38","author":"Owusu-Edusei \n K,","year":"2011","unstructured":"Owusu-Edusei \n K, \n \n \n Peterman \n TA, \n \n \n Ballard \n RC. \n \n \n Serologic testing for syphilis in the United States: a cost-effectiveness analysis of two screening algorithms. Sex Transm Dis. 2011;38(1):1\u20137."},{"issue":"1","key":"i1543-2165-141-1-93-b12","series-title":"Curr Opin Infect Dis","first-page":"79","article-title":"Which algorithm should be used to screen for syphilis?","volume":"25","author":"Binnicker \n MJ.","year":"2012","unstructured":"Binnicker \n MJ. \n \n \n Which algorithm should be used to screen for syphilis?\n Curr Opin Infect Dis. 2012;25(1):79\u201385."},{"key":"i1543-2165-141-1-93-b13","series-title":"MMWR Morb Mortal Wkly Rep","article-title":"Discordant results from reverse sequence syphilis screening\u2014five laboratories, United States, 2006\u20132010","year":"2011","unstructured":"Centers for Disease Control and Prevention (CDC). Discordant results from reverse sequence syphilis screening\u2014five laboratories, United States, 2006\u20132010. MMWR Morb Mortal Wkly Rep. 2011;60(5);133\u2013137. http:\/\/www.cdc.gov\/mmwr\/PDF\/wk\/mm6005.pdf. Accessed February 22, 2016."},{"issue":"4","key":"i1543-2165-141-1-93-b14","series-title":"J Clin Microbiol","first-page":"1501","article-title":"Validation of reverse sequence screening for syphilis","volume":"50","author":"Lipinsky \n D,","year":"2012","unstructured":"Lipinsky \n D, \n \n \n Schreiber \n L, \n \n \n Kopel \n V, \n \n \n Shainberg \n B. \n \n \n Validation of reverse sequence screening for syphilis. J Clin Microbiol. 2012;50(4):1501."},{"issue":"8","key":"i1543-2165-141-1-93-b15","series-title":"Clin Infect Dis","first-page":"1116","article-title":"Analysis of 3 algorithms for syphilis serodiagnosis and implications for clinical management","volume":"58","author":"Tong \n ML,","year":"2014","unstructured":"Tong \n ML, \n \n \n Lin \n LR, \n \n \n Liu \n LL, \n \n et al. \n Analysis of 3 algorithms for syphilis serodiagnosis and implications for clinical management. Clin Infect Dis. 2014;58(8):1116\u20131124."},{"issue":"1","key":"i1543-2165-141-1-93-b16","series-title":"Ann Lab Med","first-page":"23","article-title":"Comparison of automated treponemal and nontreponemal test algorithms as first-line syphilis screening assays","volume":"36","author":"Huh \n HJ,","year":"2016","unstructured":"Huh \n HJ, \n \n \n Chung \n JW, \n \n \n Park \n SY, \n \n \n Chae \n SL. \n \n \n Comparison of automated treponemal and nontreponemal test algorithms as first-line syphilis screening assays. Ann Lab Med. 2016;36(1):23\u201327."},{"issue":"1","key":"i1543-2165-141-1-93-b17","series-title":"J Clin Microbiol","first-page":"163","article-title":"Comparison of six automated treponema-specific antibody assays","volume":"54","author":"Park \n BG,","year":"2016","unstructured":"Park \n BG, \n \n \n Yoon \n JG, \n \n \n Rim \n JH, \n \n \n Lee \n A, \n \n \n Kim \n HS. \n \n \n Comparison of six automated treponema-specific antibody assays. J Clin Microbiol. 2016;54(1):163\u2013167."},{"issue":"12","key":"i1543-2165-141-1-93-b18","series-title":"J Eur Acad Dermatol Venereol","first-page":"1581","article-title":"2014 European guideline on the management of syphilis","volume":"28","author":"Janier \n M,","year":"2014","unstructured":"Janier \n M, \n \n \n Hegyi \n V, \n \n \n Dupin \n N, \n \n et al. \n 2014 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol. 2014;28(12):1581\u20131593."},{"issue":"RR-03","key":"i1543-2165-141-1-93-b19","series-title":"MMWR Recomm Rep","first-page":"1","article-title":"Sexually transmitted diseases treatment guidelines, 2015","volume":"64","author":"Workowski \n KA,","year":"2015","unstructured":"Workowski \n KA, \n \n \n Bolan \n GA. \n \n \n Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):1\u2013137. http:\/\/www.cdc.gov\/std\/tg2015\/tg-2015-print.pdf. Accessed February 22, 2016."},{"issue":"2","key":"i1543-2165-141-1-93-b01","series-title":"Clin Vaccine Immunol","first-page":"137","article-title":"Recent trends in the serologic diagnosis of syphilis","volume":"22","author":"Morshed \n MG,","year":"2015","unstructured":"Morshed \n MG, \n \n \n Singh \n AE. \n \n \n Recent trends in the serologic diagnosis of syphilis. Clin Vaccine Immunol. 2015;22(2):137\u2013147."},{"issue":"10","key":"i1543-2165-141-1-93-b02","series-title":"Eur J Clin Microbiol Infect Dis","first-page":"705","article-title":"Comparative evaluation of 15 serological assays for the detection of syphilis infection","volume":"26","author":"Cole \n MJ,","year":"2007","unstructured":"Cole \n MJ, \n \n \n Perry \n KR, \n \n \n Parry \n JV. \n \n \n Comparative evaluation of 15 serological assays for the detection of syphilis infection. Eur J Clin Microbiol Infect Dis. 2007;26(10):705\u2013713."},{"issue":"4","key":"i1543-2165-141-1-93-b03","series-title":"J Clin Microbiol","first-page":"1313","article-title":"Treponema-specific tests for serodiagnosis of syphilis: comparative evaluation of seven assays","volume":"49","author":"Binnicker \n MJ,","year":"2011","unstructured":"Binnicker \n MJ, \n \n \n Jespersen \n DJ, \n \n \n Rollins \n LO. \n \n \n Treponema-specific tests for serodiagnosis of syphilis: comparative evaluation of seven assays. J Clin Microbiol. 2011;49(4):1313\u20131317."},{"issue":"1","key":"i1543-2165-141-1-93-b04","series-title":"Clin Microbiol Rev","first-page":"1","article-title":"Laboratory diagnosis and interpretation of tests for syphilis","volume":"8","author":"Larsen \n SA,","year":"1995","unstructured":"Larsen \n SA, \n \n \n Steiner \n BM, \n \n \n Rudolph \n AH. \n \n \n Laboratory diagnosis and interpretation of tests for syphilis. Clin Microbiol Rev. 1995;8(1):1\u201321."},{"key":"i1543-2165-141-1-93-b05","series-title":"MMWR Morb Mortal Wkly Rep","article-title":"Syphilis testing algorithms using treponemal tests for initial screening\u2014four laboratories, New York City, 2005\u20132006","unstructured":"Centers for Disease Control and Prevention (CDC). Syphilis testing algorithms using treponemal tests for initial screening\u2014four laboratories, New York City, 2005\u20132006. MMWR Morb Mortal Wkly Rep. 2008:57(32);872\u2013875. http:\/\/www.cdc.gov\/mmwr\/PDF\/wk\/mm5732.pdf. Accessed February 22, 2016."},{"issue":"1","key":"i1543-2165-141-1-93-b06","series-title":"J Clin Lab Anal","first-page":"1","article-title":"Laboratory diagnosis of syphilis with automated immunoassays","volume":"23","author":"Marangoni \n A,","year":"2009","unstructured":"Marangoni \n A, \n \n \n Moroni \n A, \n \n \n Accardo \n S, \n \n \n Cevenini \n R. \n \n \n Laboratory diagnosis of syphilis with automated immunoassays. J Clin Lab Anal. 2009;23(1):1\u20136."},{"issue":"7","key":"i1543-2165-141-1-93-b07","series-title":"Clin Vaccine Immunol","first-page":"1084","article-title":"Evaluation of the BioPlex 2200 syphilis system as a first-line method of reverse-sequence screening for syphilis diagnosis","volume":"20","author":"Marangoni \n A,","year":"2013","unstructured":"Marangoni \n A, \n \n \n Nardini \n P, \n \n \n Foschi \n C, \n \n et al. \n Evaluation of the BioPlex 2200 syphilis system as a first-line method of reverse-sequence screening for syphilis diagnosis. Clin Vaccine Immunol. 2013;20(7):1084\u20131088."},{"issue":"1","key":"i1543-2165-141-1-93-b08","series-title":"J Clin Microbiol","first-page":"148","article-title":"Direct comparison of the traditional and reverse syphilis screening algorithms in a population with a low prevalence of syphilis","volume":"50","author":"Binnicker \n MJ,","year":"2012","unstructured":"Binnicker \n MJ, \n \n \n Jespersen \n DJ, \n \n \n Rollins \n LO. \n \n \n Direct comparison of the traditional and reverse syphilis screening algorithms in a population with a low prevalence of syphilis. J Clin Microbiol. 2012;50(1):148\u2013150."},{"issue":"6","key":"i1543-2165-141-1-93-b09","series-title":"Clin Infect Dis","first-page":"700","article-title":"Novel Treponema pallidum serologic tests: a paradigm shift in syphilis screening for the 21st century","volume":"51","author":"Sena \n AC,","year":"2010","unstructured":"Sena \n AC, \n \n \n White \n BL, \n \n \n Sparling \n PF. \n \n \n Novel Treponema pallidum serologic tests: a paradigm shift in syphilis screening for the 21st century. Clin Infect Dis. 2010;51(6):700\u2013708."},{"issue":"1","key":"i1543-2165-141-1-93-b10","series-title":"J Clin Microbiol","first-page":"2","article-title":"It is time to use treponema-specific antibody screening tests for diagnosis of syphilis","volume":"50","author":"Loeffelholz \n MJ,","year":"2012","unstructured":"Loeffelholz \n MJ, \n \n \n Binnicker \n MJ. \n \n \n It is time to use treponema-specific antibody screening tests for diagnosis of syphilis. J Clin Microbiol. 2012;50(1):2\u20136."},{"issue":"1","key":"i1543-2165-141-1-93-b11","series-title":"Sex Transm Dis","first-page":"1","article-title":"Serologic testing for syphilis in the United States: a cost-effectiveness analysis of two screening algorithms","volume":"38","author":"Owusu-Edusei \n K,","year":"2011","unstructured":"Owusu-Edusei \n K, \n \n \n Peterman \n TA, \n \n \n Ballard \n RC. \n \n \n Serologic testing for syphilis in the United States: a cost-effectiveness analysis of two screening algorithms. Sex Transm Dis. 2011;38(1):1\u20137."},{"issue":"1","key":"i1543-2165-141-1-93-b12","series-title":"Curr Opin Infect Dis","first-page":"79","article-title":"Which algorithm should be used to screen for syphilis?","volume":"25","author":"Binnicker \n MJ.","year":"2012","unstructured":"Binnicker \n MJ. \n \n \n Which algorithm should be used to screen for syphilis?\n Curr Opin Infect Dis. 2012;25(1):79\u201385."},{"key":"i1543-2165-141-1-93-b13","series-title":"MMWR Morb Mortal Wkly Rep","article-title":"Discordant results from reverse sequence syphilis screening\u2014five laboratories, United States, 2006\u20132010","year":"2011","unstructured":"Centers for Disease Control and Prevention (CDC). Discordant results from reverse sequence syphilis screening\u2014five laboratories, United States, 2006\u20132010. MMWR Morb Mortal Wkly Rep. 2011;60(5);133\u2013137. http:\/\/www.cdc.gov\/mmwr\/PDF\/wk\/mm6005.pdf. Accessed February 22, 2016."},{"issue":"4","key":"i1543-2165-141-1-93-b14","series-title":"J Clin Microbiol","first-page":"1501","article-title":"Validation of reverse sequence screening for syphilis","volume":"50","author":"Lipinsky \n D,","year":"2012","unstructured":"Lipinsky \n D, \n \n \n Schreiber \n L, \n \n \n Kopel \n V, \n \n \n Shainberg \n B. \n \n \n Validation of reverse sequence screening for syphilis. J Clin Microbiol. 2012;50(4):1501."},{"issue":"8","key":"i1543-2165-141-1-93-b15","series-title":"Clin Infect Dis","first-page":"1116","article-title":"Analysis of 3 algorithms for syphilis serodiagnosis and implications for clinical management","volume":"58","author":"Tong \n ML,","year":"2014","unstructured":"Tong \n ML, \n \n \n Lin \n LR, \n \n \n Liu \n LL, \n \n et al. \n Analysis of 3 algorithms for syphilis serodiagnosis and implications for clinical management. Clin Infect Dis. 2014;58(8):1116\u20131124."},{"issue":"1","key":"i1543-2165-141-1-93-b16","series-title":"Ann Lab Med","first-page":"23","article-title":"Comparison of automated treponemal and nontreponemal test algorithms as first-line syphilis screening assays","volume":"36","author":"Huh \n HJ,","year":"2016","unstructured":"Huh \n HJ, \n \n \n Chung \n JW, \n \n \n Park \n SY, \n \n \n Chae \n SL. \n \n \n Comparison of automated treponemal and nontreponemal test algorithms as first-line syphilis screening assays. Ann Lab Med. 2016;36(1):23\u201327."},{"issue":"1","key":"i1543-2165-141-1-93-b17","series-title":"J Clin Microbiol","first-page":"163","article-title":"Comparison of six automated treponema-specific antibody assays","volume":"54","author":"Park \n BG,","year":"2016","unstructured":"Park \n BG, \n \n \n Yoon \n JG, \n \n \n Rim \n JH, \n \n \n Lee \n A, \n \n \n Kim \n HS. \n \n \n Comparison of six automated treponema-specific antibody assays. J Clin Microbiol. 2016;54(1):163\u2013167."},{"issue":"12","key":"i1543-2165-141-1-93-b18","series-title":"J Eur Acad Dermatol Venereol","first-page":"1581","article-title":"2014 European guideline on the management of syphilis","volume":"28","author":"Janier \n M,","year":"2014","unstructured":"Janier \n M, \n \n \n Hegyi \n V, \n \n \n Dupin \n N, \n \n et al. \n 2014 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol. 2014;28(12):1581\u20131593."},{"issue":"RR-03","key":"i1543-2165-141-1-93-b19","series-title":"MMWR Recomm Rep","first-page":"1","article-title":"Sexually transmitted diseases treatment guidelines, 2015","volume":"64","author":"Workowski \n KA,","year":"2015","unstructured":"Workowski \n KA, \n \n \n Bolan \n GA. \n \n \n Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):1\u2013137. http:\/\/www.cdc.gov\/std\/tg2015\/tg-2015-print.pdf. 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