Test Catalog

Test ID: TREPE    
Treponema pallidum Immunostain, Technical Component Only

Useful For Suggests clinical disorders or settings where the test may be helpful

Identification of Treponema pallidum in tissues

Testing Algorithm Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Syphilis is caused by infection with the spirochete Treponema pallidum. Transmission of T pallidum occurs via penetration of the spirochetes through mucosal membranes and abrasions on epithelial surfaces. This test will identify T pallidum, however it also cross-reacts with other spirochetes.

Interpretation Provides information to assist in interpretation of the test results

This test does not include pathologist interpretation; only technical performance of the stain is performed. If an interpretation is required, order PATHC / Pathology Consultation for a full diagnostic evaluation or second opinion of the case.


The positive and negative controls are verified as showing appropriate immunoreactivity and documentation is retained at Mayo Clinic Rochester. If a control tissue is not included on the slide, a scanned image of the relevant quality control tissue is available upon request. Contact 855-516-8404.


Interpretation of this test should be performed in the context of the patient's clinical history and other diagnostic tests by a qualified pathologist.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Contamination and cross-reactivity with other microorganisms, including other spirochetes, may lead to nonspecific staining. Clinical and serologic correlation is recommended for diagnostic confirmation.


Age of a cut paraffin section can affect immunoreactivity. Stability thresholds vary widely among published literature and are antigen-dependent. Best practice is for paraffin sections to be cut within 6 weeks.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Muller H, Eisendle K, Brauninger W, Kutzner H, Cerroni L, Zelger B: Comparative analysis of immunohistochemistry, polymerase chain reaction and focus-floating microscopy for the detection of Treponema pallidum in mucocutaneous lesions of primary, secondary and tertiary syphilis. Br J Dermatol. 2011 Jul;165(1):50-60

2. Theel ES, Katz SS, Pillay A: Molecular and direct detection tests for Treponema pallidum subspecies pallidum: a review of the literature, 1964-2017. Clin Infect Dis. 2020 Jun 24;71(Supplement_1):S4-S12. doi: 10.1093/cid/ciaa176

3. Fukuda H, Takahashi M, Kato K, Oharaseki T, Mukai H: Multiple primary syphilis on the lip, nipple-areola and penis: An immunohistochemical examination of Treponema pallidum localization using an anti-T. pallidum antibody. J Dermatol. 2015 May;42(2):515-517