What Is Part 4 of Form I-693 (Syphilis and Gonorrhea Testing)?
Quick Answer
Part 4 of Form I-693 documents the results of required sexually transmitted infection (STI) testing. Specifically, it records the results of syphilis testing (using the RPR or equivalent serologic test) and gonorrhea testing (using NAAT). Not all applicants are required to be tested — USCIS guidelines specify which age groups must undergo each test.
Why Are STI Tests Required for Immigration?
Syphilis and gonorrhea are communicable diseases of public health significance under U.S. immigration law. USCIS requires testing for these infections as part of the immigration medical examination to identify applicants who may have active, untreated infections. Untreated syphilis in particular can have serious long-term health consequences and is a ground of inadmissibility if active and infectious.
Syphilis Testing: The RPR Test
Syphilis is screened using the Rapid Plasma Reagin (RPR) test, a non-treponemal serologic test. If the RPR is reactive (positive), a confirmatory treponemal test is performed. The civil surgeon documents both the RPR result and the confirmatory test result in Part 4. A reactive RPR with a positive confirmatory test indicates syphilis infection. The civil surgeon must then determine whether the infection is active and infectious, which affects the admissibility determination.
Gonorrhea Testing: NAAT
Gonorrhea is tested using Nucleic Acid Amplification Testing (NAAT), which is highly sensitive and specific. The NAAT test is performed on a urine sample or swab specimen. A positive NAAT result indicates active gonorrhea infection. The civil surgeon documents the result in Part 4. Active, untreated gonorrhea is a communicable disease of public health significance and must be reported.
Who Is Required to Be Tested?
USCIS technical instructions specify the age groups required to undergo syphilis and gonorrhea testing. Generally, syphilis testing is required for applicants 15 years of age and older. Gonorrhea testing requirements may differ. The civil surgeon follows the current CDC and USCIS technical instructions to determine which tests are required for each applicant based on age and other factors. Children below the required age thresholds are exempt from these specific tests.
What Happens If a Test Is Positive?
A positive syphilis or gonorrhea test does not automatically prevent immigration. The civil surgeon will refer the applicant for treatment. Once treatment is completed and the infection is resolved, the civil surgeon can document the treatment and complete the form. USCIS may require documentation of treatment completion. Applicants should not delay seeking treatment, as this can significantly extend the timeline for their immigration case.
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