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Objective: To determine the rate of the prozone phenomenon in our patient population.

Methods: Sera from 4328 patients-3504 females (2065 pregnant, 1439 nonpregnant) and 824 males-were tested for syphilis by the rapid plasma reagin (RPR) test, and then rechecked with serial twofold dilutions of up to 16-fold to detect the prozone phenomenon. Chi-square analysis with Yates correction was used, with P <= .05 considered significant.

Results: The total positivity rate in females was 6% (213 patients); 13% (27) of the positive tests were false-positive reactions as confirmed by a negative anti-treponemal antibody test. Only one prozone reaction was detected, in serum from a male subject, but it was not missed on initial screening.

Conclusion: The rate of prozone phenomenon is very low (95% confidence interval 0-0.4%), and routine serial dilutions are not cost effective.

(C) 1994 The American College of Obstetricians and Gynecologists