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. Weiping Cao at 404-639-5443 or stdlaboratoryspecim@cdc.gov.

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

Components of Research Description

Background and Objective:

Public Health Importance:

A statement that your institution has a biosafety office and that your facility can safely work with blood borne pathogens:

How the results will be used:

Specific specimen categories requested:(optional)

The requestor’s current association/affiliation:

Address Line 1:

Address Line 2:(optional)

City:

State:

Zip Code:

Phone:

Email:

Page last reviewed: November 4, 2021

Content source: Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention

Syphilis Serum Request Form

Components of Research Description

See Also

Follow STD