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Diagnostic Tests for Syphilis Continue to Perplex Even the Experts: An Unanswerable Question in Infectious Diseases - HIV and ID Observations: Here’s a tricky clinical scenario: An elderly person with cognitive decline or some other non-specific neurologic symptom sees a clinician. Clinician sends a syphilis screen with a T. pallidum enzyme immunoassay (TP-EIA), which returns positive. Lab runs a confirmatory test — a T. pallidum particle agglutination test (TP-PA), or similar, which also returns positive. The lab then runs a rapid plasma reagin (RPR) test, which returns negative. There is no known prior clinical or lab history of syphilis exposure, diagnosis, or treatment.
Now what are we supposed to do?