tp positive tppa negative syphilis spirochete antibody positive, syphilis spirochete particles agglutination test negative, may be syphilis false positive, may also be very early syphilis. 1. False-positive syphilis: actually not infected with syphilis, seen in pregnant women, the elderly, patients with tumors, dialysis patients, etc. This group of people with decreased immune regulation, endocrine environmental factors such as changes that lead to the production of autoantibodies in the body, such as anti-TP antibodies and the occurrence of biological false-positive. 2. Very early syphilis: some patients with syphilis infection have high serum antibody concentration, leading to an imbalance in the ratio of antigen to antibody, and the excess antibody forms fewer immune complexes without agglutination, leading to false-negative TPPA results. In short, tp positive tppa negative need regular review, if diagnosed early syphilis, timely treatment.