The Legal Basis for Syphilis Testing

Under the Immigration and Nationality Act (INA), USCIS requires screening for communicable diseases of public health significance as part of the immigration medical examination. Syphilis — particularly in its infectious stages (primary, secondary, and early latent) — falls within this category.

The Centers for Disease Control and Prevention (CDC) and USCIS have established that all applicants aged 15 and older must be tested for syphilis using a serologic blood test. This requirement reflects the public health significance of syphilis and the availability of effective treatment.

How the Syphilis Test Works

Syphilis testing for immigration purposes uses a two-step serologic process. The first step is a non-treponemal screening test — most commonly the RPR (rapid plasma reagin) — which detects antibodies produced in response to syphilis infection. If the RPR is reactive, a confirmatory treponemal test is ordered to confirm the diagnosis.

Both tests are performed on a blood sample drawn on-site at our Costa Mesa clinic. The blood draw takes only a few minutes. Results are typically available within 1 to 2 business days.

• Step 1: RPR (rapid plasma reagin) screening test — blood draw on-site
• Step 2: Confirmatory treponemal test if RPR is reactive
• Results available within 1–2 business days
• No fasting or special preparation required

What a Reactive RPR Result Means

A reactive RPR result does not automatically mean you have active syphilis. The RPR can be reactive in people with a history of treated syphilis, certain other infections, or autoimmune conditions. This is why a confirmatory treponemal test is required before any clinical determination is made.

If both the RPR and the confirmatory test are reactive, the civil surgeon will evaluate the stage of infection and whether treatment has been completed. The clinical history, physical examination findings, and laboratory results are all considered together.

What Happens If Active Syphilis Is Found

If active syphilis is identified — meaning the infection is in an infectious stage and has not been treated — treatment will be required before Form I-693 can be finalized. Syphilis is highly treatable with antibiotics, typically penicillin. Treatment is effective and usually completed within a few weeks.

Our civil surgeon will discuss your options and refer you to appropriate care if needed. Once treatment is completed and documented, your Form I-693 can be finalized. Active infectious syphilis is a ground of inadmissibility, but this is resolved once treatment is complete.

Treated Syphilis and Your Green Card

A history of treated syphilis — with documented cure — is generally not a ground of inadmissibility under U.S. immigration law. If you have been treated for syphilis in the past, bring any documentation of your treatment to your appointment. This can help the civil surgeon complete your Form I-693 accurately and efficiently.

The civil surgeon will document the finding on Form I-693 along with the treatment history. USCIS reviews this documentation as part of the overall medical evaluation.

Who Is Exempt From Syphilis Testing

Applicants under 15 years of age are not required to undergo syphilis testing as part of the standard immigration medical examination. All other applicants — regardless of gender, marital status, or country of origin — are required to be tested.