Positive Syphilis Test: Clear Steps to Take Right Now

Getting a positive syphilis test can feel scary, but a single result is only part of the story. Tests come in two main types and doctors use them together to figure out whether you have an active infection, a past treated infection, or a false positive. Knowing what each test checks for helps you act fast and get the right care.

What a positive test means

Nontreponemal tests (RPR or VDRL) look for antibodies your body makes when the disease is active. These tests give a titer number that doctors use to follow treatment. Treponemal tests (TPPA, FTA-ABS, or EIA) look for antibodies specific to the syphilis bacteria and usually stay positive for life after infection.

If both a nontreponemal and a treponemal test are positive, that usually means you have an infection now or had one in the past. If only the treponemal test is positive, it might mean a past treated infection. If only the nontreponemal is positive, a repeat or confirmatory test is needed because false positives happen (pregnancy, some autoimmune diseases, recent infections, or certain vaccines can cause this).

Next steps: testing, treatment, and follow-up

First, ask for a confirmatory treponemal test if you haven’t had one. Your provider will want to know symptoms, sexual history, and whether you have HIV—co-testing is standard because HIV and syphilis often occur together.

Treatment is straightforward in most cases. Early syphilis is usually treated with a single shot of benzathine penicillin G. Later stages need longer courses. If you’re allergic to penicillin, doctors may use doxycycline or refer you for desensitization—pregnant people must get penicillin, so desensitization is used if allergic.

Avoid sex until you and your partners finish treatment and follow-up testing confirms the infection is no longer active. Tell recent partners so they can get tested and treated if needed; many clinics and health departments will help with partner notification confidentially.

Follow-up blood tests matter. Your doctor will likely repeat the nontreponemal test at set intervals (for example, about 6 and 12 months after treatment for early syphilis) to confirm the titer falls. If titers don’t drop as expected, more evaluation is needed.

Where to go: sexual health clinics, your primary care doctor, or an infectious disease specialist. Public health clinics can often provide testing and free or low-cost treatment and help with partner notification.

Quick practical tips: don’t delay treatment if tests confirm syphilis; get an HIV test; tell recent partners; and if you’re pregnant, get treated right away. Getting care early prevents complications and stops spread to others.

If you want, I can help you find local clinics, explain test results line-by-line, or draft a message to notify partners. What would help you most right now?