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How to test for syphilis

Dec 01, 2025 Source: Cainiu Health
Dr. Liu Wenmin
Introduction
The main diagnostic methods for syphilis include screening for Treponema pallidum antibodies, non-treponemal antibody testing, dark-field microscopy examination for Treponema pallidum, cerebrospinal fluid analysis, and imaging studies. Appropriate tests should be selected based on medical history and clinical symptoms. Individuals with a history of high-risk exposure or symptoms such as chancre should seek prompt medical evaluation and testing.

Methods for syphilis testing mainly include screening for *Treponema pallidum* antibodies, non-treponemal antibody testing, dark-field microscopic examination of *Treponema pallidum*, cerebrospinal fluid (CSF) analysis, and imaging studies. The appropriate tests should be selected based on medical history and clinical symptoms. Individuals with a history of high-risk exposure or symptoms such as chancre should seek timely medical evaluation.

1. *Treponema pallidum* Antibody Screening: This blood test detects the presence of antibodies against *Treponema pallidum* and is commonly used for initial screening. It is simple and rapid, providing a preliminary indication of infection, but cannot differentiate between past and current infections.

2. Non-treponemal Antibody Testing: Often used to confirm positive screening results, this test measures antibody titers and helps assess disease activity and treatment response. Changes in titer levels can reflect disease progression or improvement.

3. Dark-Field Microscopic Examination of *Treponema pallidum*: A sample from suspected lesions or body fluids is examined under a dark-field microscope to directly observe the presence of *Treponema pallidum*. This method allows definitive diagnosis of early syphilis, especially during the chancre stage.

4. Cerebrospinal Fluid (CSF) Analysis: For patients with late-stage syphilis or suspected neurosyphilis, CSF is collected via lumbar puncture to test for *Treponema pallidum*-related markers, helping determine whether the nervous system is involved.

5. Imaging Studies: Techniques such as X-ray, CT, and MRI are used to evaluate whether syphilis has affected bones, the cardiovascular system, or other organs. These help diagnose complications of late-stage syphilis and guide treatment planning.

Prior to testing, inform your doctor about any history of high-risk exposure and symptoms to avoid misdiagnosis due to incomplete information. After testing, keep the puncture site clean and dry to prevent infection. Remain calm while awaiting results and follow medical advice for further diagnosis, treatment, and follow-up examinations.

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