Despite the success of multidrug therapy in reducing the number of registered leprosy cases worldwide, evidence suggests that Mycobacterium leprae continues to be transmitted. A serological diagnostic test capable of identifying and allowing treatment of early-stage disease could reduce transmission and prevent the onset of the disability, a common complication of the disease in later stages. Serological diagnosis based on antibody recognition of phenolic glycolipid I (PGL-I) cannot reliably identify individuals with lower bacterial indices (BI). One strategy that might improve this situation is the provision of highly specific serological antigens that may be combined with PGL-I to improve the sensitivity of diagnosis. Using serological expression cloning with a serum pool of untreated lepromatous leprosy (LL) patients, we identified 14 strongly reactive M. leprae proteins, 5 of which were previously unstudied. We present results suggesting that two of these proteins, ML0405 and ML2331, demonstrate the ability to specifically identify LL/borderline lepromatous (BL) patients on the basis of immunoglobulin G (IgG) reactivity. In a household contact study, LL index cases were identified on the basis of this reactivity, while household contacts of these patients demonstrated undetectable reactivity. At a serum dilution of 1:800, suitable to reduce background PGL-I IgM reactivity, two BL patients with a BI of <4 showed anti-human polyvalent immunoglobulin G, A, and M reactivity measured with a combination of ML0405, ML2331, and natural disaccharide O-linked human serum albumin (NDOHSA) (synthetic PGL-I) that was markedly higher than IgM reactivity to NDOHSA alone. We suggest that ML0405 and ML2331 may have utility in serological leprosy diagnosis.Leprosy is a devastating human disease caused by infection with Mycobacterium leprae bacilli. The disease predominantly affects the skin, although during infection, significant nerve destruction leads to deformities of the hand, foot, face, and, in some cases, eye (1). The disease is represented by a clinical spectrum. Lepromatous leprosy/borderline lepromatous (LL/ BL) patients represent one pole of the spectrum, demonstrating a high bacterial index (BI) and, as such, are classified as multibacillary (MB). LL/BL patients demonstrate high titers of M. leprae-specific antibodies and an absence of M. leprae-specific cell-mediated immunity. At the opposite pole, tuberculoid tuberculoid/borderline tuberculoid (TT/BT) patients demonstrate very low or absent BI and are designated paucibacillary. These individuals demonstrate significant M. leprae-specific cellmediated immunity and very low or absent titers of M. lepraespecific antibodies.Despite the success of multidrug therapy in reducing the number of registered leprosy cases worldwide, the annual rate of new case detection remains unchanged, at approximately 700,000 cases per year (33), with children representing 15% of new cases (18). This suggests that active transmission of M. leprae is still occurring, but the route and me...