After a positive non-treponemal screening test for syphilis, which confirmatory test should be used?

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When a non-treponemal screening test is positive, the next step is to confirm the finding with a treponemal-specific assay to verify true infection. Treponemal tests such as TP-PA, FTA-ABS, or treponemal immunoassays are more specific for Treponema pallidum and help distinguish true syphilis from false-positive non-treponemal results; they typically remain positive for life after infection. Some labs use a reverse algorithm where a treponemal test is used first, then a non-treponemal test for confirmation or activity, but after a positive non-treponemal screen, the confirmatory step is a treponemal test to establish infection.