Prevalence of untreated syphilis in veterans: a case for routine screening

Abstract

Despite a marked increase in the prevalence of syphilis over the last several years, routine syphilis screening in unselected populations is not generally recommended. To assess the value of syphilis screening, we studied both retrospectively and prospectively the prevalence of untreated or inadequately treated syphilis in patients attending a Veterans Administration hospital during 1987 and 1988. Of the 3,800 general hospital patients who underwent RPR testing, 36 (0·9%) were identified. Routine syphilis screenign detected 13 of these 36 cases. A prospective study of RPR screening in drug rehabilitation, alcohol rehabilitation, and psychiatry patients identified infection in 2·9%, 1·1% and 0% of patients, respectively. A third study utilizing both FTA and RPR screening in patients undergoing examination for assessment of service-connected disability detected infection in 5 of 304 (1·6%) patients, four of whom had positive FTA serology but negative RPR tests. We conclude that undetected and advanced syphilis, including neurosyphilis, is prevalent in veterans, and recommend pilot studies of screening in these and other non-veteran populations to determine the need for reinstitution of routine syphilis testing.