Rapid plasma reagent

Overview
Rapid Plasma Reagent (RPR) refers to a type of test that looks for non-specific antibodies in the blood of the patient that may indicate that the organism (Treponema pallidum) that causes syphilis is present. The term "reagin" means that this test does not look for antibodies against the actual bacterium, but rather for antibodies against substances released by cells when they are damaged by T. pallidum. Another test often used to screen for syphilis is the Venereal Disease Research Laboratory VDRL slide test, however, the RPR test is generally preferred due to its ease of use.

In addition to screening for syphilis, an RPR level (also called a "titer") can be used to track the progress of the disease over time and its response to therapy.

The RPR test is an effective screening test, meaning it is very good at detecting people who are affected by syphilis, however, this comes with the drawback that this test is also known to show that people have syphilis who in reality do not (in other words, it will produce false positives). False positives can be seen in viral infections (Epstein-Barr, hepatitis, varicella, measles), lymphoma, tuberculosis, malaria, endocarditis, connective tissue disease, pregnancy, intravenous drug abuse, or contamination. As a result, these two screening tests should always be followed up by a more specific treponemal test. Tests based on monoclonal antibodies and immunofluorescence, including Treponema pallidum hemagglutination assay (TPHA) and Fluorescent Treponemal Antibody Absorption (FTA-ABS) are more specific and more expensive. Unfortunately, false positives can still occur in related treponomal infections such as yaws and pinta. Tests based on enzyme-linked immunoassays are also used to confirm the results of simpler screening tests for syphilis.

Other types of tests are currently being evaluated as possible alternatives to, or as replacements for, the rapid plasma reagin test. One of these alternatives is an immunochromographic strip test. A study published in February 2006 found that this test outperformed the RPR test in values of sensitivity and specificity, and it does not require a laboratory to process the results.

Related chapters

 * Syphilis
 * Venereal Disease Research Laboratory test

Additional Resources

 * Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, and Isselbacher KJ. Harrison's Principles of Internal Medicine, 16th ed. 2005.


 * Montoya, PJ, Lukehart SA, Brentlinger PE, Blanco AJ, Floriano F, Sairosse J, and Gloyd S. "Comparison of the diagnostic accuracy of a rapid immunochromagraphic test and the rapid plasma reagin test for antenatal syphilis screening in Mozambique." Bulletin of the World Health Oranization. 2006 Feb; 84(2):97-104.


 * Deeb, Benjamin. "Rapid Plasma Reagin and Syphilis, Effective Rates."  "Journal of American Sexual Health." 2007 Jan; 37(1):48-72.
 * Sacher RA, McPherson RA, and Campos JM. Wildman's Clinical Interpretation of Laboratory Tests, 2nd ed. 2000.