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It was only in the 20th century that effective tests and treatments for syphilis were developed.
In 1906, the first effective test for syphilis, the Wassermann test, was developed. Although it had some false positive results, it was a major advance in the prevention of syphilis. By allowing testing before the acute symptoms of the disease had developed, this test allowed the prevention of transmission of syphilis to others, even though it did not provide a cure for those infected. In the 1930s the Hinton test, developed by William Augustus Hinton, and based on flocculation, was shown to have fewer false positive reactions than the Wasserman test. Both of these early tests have been superseded.
Present-day syphilis tests, such as the Rapid Plasma Reagin (RPR) and Venereal Disease Research Laboratory (VDRL) tests, while useful, are still not completely specific, as many other conditions can cause a positive result. Tests based on monoclonal antibodies and immunofluorescence, including Treponema pallidum haemagglutination assay (TPHA) and Fluorescent Treponemal Antibody Absorption (FTA-ABS), are more specific, but are still unable to rule out 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. However, a simple microscopy of chancre fluid using dark ground illumination provide a quick and effective test. As there are other treponemes that may be confused with T. pallidum, care must be taken in evaluating such specimens.
Neurosyphilis is diagnosed by finding lymphocytes in the CSF in the presence of positive syphilis serology. There is anecdotal evidence that the incidence of neurosyphilis is higher in HIV patients, and some have recommended that all HIV-positive patients with a diagnosis of syphilis should also have a lumbar puncture to look for asymptomatic neurosyphilis.
In the July 17, 1998 issue of the journal Science, a group of biologists reported complete sequencing of the genome of T. pallidum.
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