Syphilis Serum Request Form

CDC and the Association of Public Health Laboratories developed a Syphilis Serum Repository. The repository is composed of residual syphilis positive serum samples tested and submitted by U.S. state and local public health laboratories. Samples may be requested from CDC in order to facilitate research and development of syphilis diagnostic tests. For an explanation of this form and the process to request specimens, see CDC/APHL Syphilis Serum Repository. For any questions about this form, please contact Dr. Allan Pillay at 404-639-2140 or

All fields on the form must be completed in order for a request to be considered.

Components of Research Description

Primary syphilis treated
Primary syphilis untreated
Secondary syphilis treated
Secondary syphilis untreated
Latent syphilis treated
Latent syphilis untreated
Specimens reported as serofast

Requestor Information