USPSTF Updates Recommendations for Syphilis Screening

In 2014, the number of primary and secondary cases in the US reached 19,999
In 2014, the number of primary and secondary cases in the US reached 19,999

The US Preventative Services Task Force (USPSTF) has made an A recommendation to screen for syphilis infection in nonpregnant persons deemed at increased risk. A recommendation signifies that the Task Force believes with high certainty that the benefits of screening outweigh the harms. The A recommendation to screen for syphilis in pregnant women was made by the USPSTF in 2009.

The growing number of primary and secondary cases of syphilis since 2000 was cited as a main reason for the recommendation. In 2014, the number of primary and secondary cases in the US reached 19,999 (6.3 cases per 100,000 persons), according to the Centers for Disease Control and Prevention's (CDC) ‘Sexually Transmitted Disease Surveillance 2014'. 

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If untreated, syphilis can progress to late-stage disease, which occurs in approximately 15% of those infected. Symptoms of late-stage disease include inflammatory lesions, and cardiovascular or organ dysfunction. Early treatment of infected patients with antibiotics can cure the disease and prevent sexual transmission to others.

Providing clinical guidance for assessment, the USPSTF cite 2014 surveillance data which showed that men who have sex with men (MSM) and those living with HIV have the highest risk for syphilis infection. Other factors to be taken into account when deciding who may be at increased-risk are factors such as incarceration, history of commercial sex work, and being male and under 29 years of age. In 2014, men accounted for 90.8% of all cases, while those aged between 20 and 29 had three times higher rates of infection than other ages.

Although automated tests are currently in development, the most reliable method of screening for syphilis is 2-step. First the nontreponemal test (RPR or VDRL) is conducted, if positive it is followed by a treponemal test (TP-PA or FTA-ABS).

The CDC presently recommends at least annual screening for sexually active MSM and persons living with HIV, additionally the CDC recommends screening for individuals in correctional facilities on the basis of location and institutional prevalence.

Concerning the updated recommendations to screen nonpregnant persons at increased risk, the researchers conclude, “Effective treatment with antibiotics can prevent progression to late-stage disease, with small associated harms, providing an overall substantial health benefit.”

For more information visit USPSTF.org.

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