Screening For Syphilis Infection Research Articles

USPSTF reaffirms recommendations on screening for syphilis infection.

USPSTF reaffirms recommendations on screening for syphilis infection.

Screening for Syphilis Infection in Nonpregnant Adults and Adolescents

This systematic review to support the 2022 US Preventive Services Task Force Recommendation Statement on screening for syphilis infection summarizes published evidence on the benefits and harms of screening for syphilis infection in asymptomatic, nonpregnant adults and adolescents at increased risk for syphilis infection.

Screening for Syphilis Infection in Pregnant Women: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

(Abstracted from JAMA 2018;320(9):918–925) Congenital syphilis is an infectious disease caused by the vertical transmission of Treponema pallidum; thus, prevention and detection of congenital syphilis depend on the identification of syphilis in pregnant women. Two screening protocols are commonly used: the traditional screening algorithm (ie, nontreponemal testing with reflex to treponemal testing) and the reverse sequence screening algorithm (ie, treponemal testing with reflex to nontreponemal testing).

Screening for Syphilis Infection in Nonpregnant Adults and Adolescents

In 2014, 19,999 cases of syphilis were reported in the United States. Left untreated, syphilis can progress to late-stage disease in about 15% of persons who are infected. Late-stage syphilis can lead to development of inflammatory lesions throughout the body, which can lead to cardiovascular or organ dysfunction. Syphilis infection also increases the risk for acquiring or transmitting HIV infection. To update the 2004 US Preventive Services Task Force (USPSTF) recommendation on screening for syphilis infection in nonpregnant adults. Screening for syphilis in pregnant women was updated in a separate recommendation statement in 2009 (A recommendation). The USPSTF reviewed the evidence on screening for syphilis infection in asymptomatic, nonpregnant adults and adolescents, including patients coinfected with other sexually transmitted infections (such as HIV). The USPSTF found convincing evidence that screening for syphilis infection in asymptomatic, nonpregnant persons at increased risk for infection provides substantial benefit. Accurate screening tests are available to identify syphilis infection in populations at increased risk. Effective treatment with antibiotics can prevent progression to late-stage disease, with small associated harms, providing an overall substantial health benefit. The USPSTF recommends screening for syphilis infection in persons who are at increased risk for infection. (A recommendation).

JAMA PATIENT PAGE. Screening for Syphilis.

The US Preventive Services Task Force (USPSTF) has published updated recommendations on screening for syphilis infection in adults and adolescents. Syphilis is a sexually transmitted infection caused by bacteria called Treponema pallidum. There are different stages of syphilis, and each stage has different symptoms. Primary syphilis occurs 2 or 3 weeks after infection, with symptoms of 1 or more small, painless ulcers (chancres) in areas of sexual contact. Because the chancres are painless and go away on their own, many people do not seek treatment. This can lead to secondary syphilis a few weeks or months later. Symptoms of secondary syphilis include flulike symptoms, fever, a widespread rash, and swollen lymph nodes. If still left untreated, these symptoms disappear and a period of latent syphilis follows that can last for several years and during which people may have no symptoms. Symptoms of tertiary syphilis (or late-stage syphilis) can arise, which include serious damage to many organs such as the heart, brain, spinal cord, and bones.

Screening for Syphilis: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.

Screening for syphilis infection is currently recommended for high-risk individuals, including those with previous syphilis infection, an infected sexual partner, HIV infection, or more than 4 sex partners in the preceding year. To update a 2004 systematic review of studies of syphilis screening effectiveness, test accuracy, and screening harms in nonpregnant adults and adolescents. Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews through October 2015 and Ovid MEDLINE (January 2004 to October 2015), with updated search through March 2016. English-language trials and observational studies of screening effectiveness, test accuracy, and screening harms in nonpregnant adults and adolescents. One investigator abstracted data, a second checked data for accuracy, and 2 investigators independently assessed study quality using predefined criteria. Transmission of disease, including HIV; complications of syphilis; diagnostic accuracy; and harms of screening. No evidence was identified regarding the effectiveness of screening on clinical outcomes or the effectiveness of risk assessment instruments; the harms of screening; or the effectiveness of screening in average-risk, nonpregnant adolescents or adults or high-risk individuals other than men who have sex with men (MSM) or men who are HIV positive. Four non-US studies indicated higher rates of syphilis detection with screening every 3 months vs 6 or 12 months for early syphilis in HIV-positive men or MSM. For example, there was an increased proportion of asymptomatic, higher-risk MSM in Australia (n = 6789 consultations) receiving a diagnosis of early syphilis when tested every 3 months vs annually (53% vs 16%, P = .001), but no difference among low-risk MSM. Treponemal and nontreponemal tests were accurate in asymptomatic individuals (sensitivity >85%, specificity >91%) in 3 studies but required confirmatory testing. Reverse sequence testing with an initial automated treponemal test yielded more false reactive test results than with rapid plasma reagin in 2 studies, one with a low-prevalence US population (0.6% vs 0.0%, P = .03) and another in a higher-prevalence Canadian population (0.26% vs 0.13%). Screening HIV-positive men or MSM for syphilis every 3 months is associated with improved syphilis detection. Treponemal or nontreponemal tests are accurate screening tests but require confirmation. Research is needed on the effect of screening on clinical outcomes; effective screening strategies, including reverse sequence screening, in various patient populations; and harms of screening.

Screening for Syphilis Infection in Pregnant Women: Evidence for the U.S. Preventive Services Task Force Reaffirmation Recommendation Statement

In 2004, the U.S. Preventive Services Task Force strongly recommended that clinicians screen all pregnant women for syphilis infection. To update the evidence on screening pregnant women for syphilis infection. MEDLINE searches from 1 January 2003 through 31 July 2008, recent systematic reviews, reference lists of retrieved articles, and expert suggestions. English-language studies were selected to answer the following 2 questions: Does screening for syphilis in pregnancy reduce the prevalence of congenital syphilis in neonates? Are there harms of screening for syphilis or harms of treatment with penicillin in pregnancy to women or neonates? Randomized, controlled trials; meta-analyses; systematic reviews; cohort studies; and ecologic studies were selected for the potential benefits question. Randomized, controlled trials; meta-analyses; systematic reviews; cohort studies; case-control studies; and large case series were selected for the potential harms question. Information on the study design, selection criteria, demographic characteristics, and clinical outcomes was extracted from each study. One study on benefits evaluated the effect before and after the implementation of a universal syphilis screening program for pregnant women and found reductions in rates of congenital syphilis. Two studies on screening accuracy for syphilis reported false-positive rates of less than 1%. One study that used a large insurance claims database reported an incidence of anaphylaxis after oral penicillin of 0.1 per 10,000 dispensings. In a study from Hungary, oral penicillin in pregnancy was not associated with orofacial clefts. This was a targeted literature search and could have missed small studies on the benefits and harms of screening for syphilis in pregnancy. We did not review evidence on interventions to improve rates of prenatal screening. New evidence from a study of universal screening supports previous evidence on the effectiveness of screening for syphilis in pregnancy to prevent congenital syphilis. Harms include testing and follow-up for false-positive test results and adverse effects from penicillin treatment.

Screening for Syphilis Infection in Pregnancy: U.S. Preventive Services Task Force Reaffirmation Recommendation Statement

Update of the 2004 U.S. Preventive Services Task Force statement about screening for syphilis in pregnancy. The U.S. Preventive Services Task Force did a targeted literature search for evidence on the benefits of screening, the harms of screening, and the harms of treatment of syphilis with penicillin during pregnancy. Screen all pregnant women for syphilis infection. (Grade A recommendation.).

Screening for Syphilis Infection: Recommendation Statement: United States Preventive Services Task Force

Screening for Syphilis Infection: Recommendation Statement: United States Preventive Services Task Force