ANKMJ
Ankyra Medical Journal

Ankyra Medical Journal (AnkMJ), formerly known as the Journal of Translational and Practical Medicine, regularly publishes international quality issues in the field of Medicine in the light of current information.

eISSN: 3023-655X
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Online Manuscript System

Index
Original Article
Evaluation of RPR, TPHA and ELISA test results used in the diagnosis of syphilis at a university hospital
Abstract
Aims: This study aimed to evaluate the laboratory results of treponemal and non-treponemal serological tests used in the diagnosis of syphilis and to investigate the diagnostic contributions of different testing algorithms.
Methods: Between April 2023 and June 2025, serum samples from 600 patients who underwent all three tests in the Microbiology Laboratory were retrospectively analyzed. The Rapid Plasma Reagin (RPR), Treponema pallidum Hemagglutination Assay (TPHA) and Enzyme-Linked Immunosorbent Assay (ELISA) tests were performed according to the manufacturers’ instructions, and the results were evaluated within both conventional and reverse algorithm frameworks.
Results: In 89.5% of cases (n=537), all three tests were negative, while at least one test was positive in 10.5% (n=63). ELISA showed the highest positivity rate, with 63 reactive samples. A total of 20 cases were positive across all three tests simultaneously. Samples positive only by ELISA were notably increased in the age group over 60 years. RPR positivity was lower compared to treponemal tests. Within the reverse algorithm, discrepancies between ELISA-positive and RPR-negative results were observed at a notable frequency.
Conclusion: Using treponemal tests as the first step in syphilis screening provides a more sensitive approach. Positive results should be confirmed with a second treponemal test, while non-treponemal tests are essential for assessing active infection and treatment monitoring. Higher ELISA positivity in older individuals suggests more false positives. The study underscores the need for laboratory–clinical collaboration and larger prospective studies.

Keywords : Syphilis, serologic tests, algorithms

Download Article


1. Peeling RW, Mabey D, Chen XS, Garcia PJ. Syphilis. Lancet. 2023; 402(10398):336-346. doi:10.1016/S0140-6736(22)02348-0
2. Forrestel AK, Kovarik CL, Katz KA. Sexually acquired syphilis: laboratory diagnosis, management and prevention. J Am Acad Dermatol. 2020;82(1):17-28. doi:10.1016/j.jaad.2019.02.074
3. Şamlıoğlu P. Evaluation of one-year rapid plasma reagin (RPR) and Treponema pallidum hemagglutination assay (TPHA) results in a tertiary public hospital. Clin Med Sci. 2018;6(2):9-11. doi:10.5222/TMCD.2018.0
4. Basgalupp S, Dornelles T, Pedrotti L, et al. Diagnostic properties of different serological methods for syphilis testing in Brazil. Diagnostics (Basel). 2025;15(12):1448. doi:10.3390/diagnostics15121448
5. Simcic S, Potocnik M. Serological diagnosis of syphilis: a comparison of different diagnostic methods. Acta Dermatovenerol Alp Pannonica Adriat. 2015;24(2):17-20. doi:10.15570/actaapa.2015.6
6. Vural DG, Ateş E, Çaycı YT, Bilgin K, Birinci A. Evaluation of five-year rapid plasma reagin (RPR) and Treponema pallidum hemagglutination assay (TPHA) results in a university hospital. Value Health Sci. 2024; 14(2):198-203. doi:10.5222/ValueHealthSci.2024.198
7. Karaca Y, Çöplü N, Gözalan A, Öncül Ö, Akın L, Esen B. Establishment of an algorithm for serological testing of syphilis identification. Mikrobiyol Bul. 2010;44(1):35-45. doi:10.5578/mb.8891
8. Binnicker MJ, Jespersen DJ, Rollins LO. 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):148-150. doi:10.1128/JCM.05636-11
9. Sönmez C. Evaluation of RPR and TPHA test results and diagnostic algorithms used in syphilis diagnosis. Turk J Med Sci. 2018;48(1):72-77. doi:10.3906/sag-1706-100
10. Ziver T, Yüksel P, Güngördü Z, İzmirli S. Evaluation of rapid plasma reagin (RPR) and Treponema pallidum hemagglutination assay (TPHA) test results used in the diagnosis of syphilis infections between 2005 and 2010. Turk J Hyg Exp Biol. 2011;68(1):1-7. doi:10.5505/TurkHijyen. 2011.88700
11. Seña AC, White BL, Sparling PF. Novel Treponema pallidum serologic tests: a paradigm shift in syphilis screening for the 21st century. Clin Infect Dis. 2010;51(6):700-708. doi:10.1086/655832
12. Radolf JD, Bolan G, Park IU, et al. Discordant results from reverse sequence syphilis screening—five laboratories, United States, 2006-2010. MMWR Morb Mortal Wkly Rep. 2011;60(5):133-157.
13. Negash M, Wondmagegn T, Geremew D. Comparison of RPR and ELISA with TPHA for the diagnosis of syphilis: implication for updating syphilis point-of-care tests in Ethiopia. J Immunol Res. 2018; 2018:2978419. doi:10.1155/2018/2978419
14. Nah EH, Cho S, Kim S, Cho HI, Chai JY. Comparison of traditional and reverse syphilis screening algorithms in medical health checkups. Ann Lab Med. 2017;37(6):511-515. doi:10.3343/alm.2017.37.6.511
15. Clement ME, Okeke NL, Hicks CB. Treatment of syphilis: a systematic review. JAMA. 2014;312(18):1905-1917. doi:10.1001/jama.2014.13259
16. Cheng A, Das A, Styles CE, Naing Z, Rawlinson WD, Gosbell IB. Improved efficiency using sequential automated immunoassays for syphilis screening in blood donors. J Clin Microbiol. 2024;62(8): e0047624. doi:10.1128/jcm.00476-24
17. Ortiz DA, Shukla MR, Loeffelholz MJ. The traditional or reverse algorithm for diagnosis of syphilis: pros and cons. Clin Infect Dis. 2020; 71(Suppl 1):S43-S51. doi:10.1093/cid/ciaa307
Article available in :
Volume 5, Issue 2, 2026
Page : 46-49
https://doi.org/10.51271/ANKMJ-0065
Article Information
Received : 03 Oca 2026
Accepted : 28 Oca 2026
Published : 25 Mar 2026
Corresponding Author :

Canberk Çınar: Department of Medical Microbiology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkiye

[email protected]
Citation : Çınar C, Yener AT, Gür Vural D, Tanrıverdi Çaycı Y, Bilgin K, Birinci A. Evaluation of RPR, TPHA and ELISA test results used in the diagnosis of syphilis at a university hospital. Ank Med J. 2026;5(2):46-49. doi:10.51271/ANKMJ-0065

Read: 99
Download : 137
Cited: 0
_Footer