Syphilis screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2] Muhammad Saad, M.B.B.S.[3]

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## Overview

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Screening guidelines for syphilis include all high risk non-pregnant individuals aged 15-65, all pregnant females, men who have sex with men, women who have sex with women, and HIV positive individuals.[1] Routine screening of adolescents who are asymptomatic for syphilis is not recommended.[2][3]

## Screening

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Screening guidelines for syphilis are:

### Non-pregnant adults and adolescents (age 15-65)

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* All individuals who are at increased risk for syphilis should be screened for syphilis Grade A recommendation.[1][4]
* Routine screening of adolescents who are asymptomatic for syphilis is not recommended.[2]

### Pregnant women

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* At first prenatal visit[5]
* Retest at early third trimester and delivery if high risk[3]
* High risk populations which require frequent screening include:[3]

* Uninsured women
* Women living in poverty
* Sex workers
* Illicit drug users
* Presence of other sexually transmitted diseases (STDs)
* Other women living in communities with high syphilis morbidity

### Men who have sex with men

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* Annually for sexually active men who have sex with men[5]
* Every 3 to 6 months if increased risk

### Women who have sex with women

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* Routine screening is recommended[2]

### HIV positive individuals

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* At first HIV evaluation for sexually active individuals[5][6]
* Annually after first evaluation
* More frequent testing for individuals who are at increased risk or are residing in highly prevalent areas of syphilis

#### Recommended approaches:

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Recommended approaches by Centers for Diseases Control and Prevention(CDC), US Preventive Services Task Force(USPTF), and American College of Obstetricians and Gynecologists(ACOG) are as follows: [7] [8] [9] [10]

Recommended Approaches to Syphilis Screening  Population | CDC | USPSTF | ACOG

|
|
|

Nonpregnant adults | Screen all sexually active people aged 15-44 years in counties with primary and secondary syphilis rates among females >4.6/1000005At least annual syphilis screening for men who have sex with men and people with HIV

More frequent screening(3-6 months) for individuals with increased vulnerability(MSM, people with HIV, history of incarceration or transactional sex, risk behaviors, people having multiple partners)

Screen asymptomatic patients at increased risk

| All nonpregnant adults should be screened for syphilis if at increased risk of infections  |
During Pregnancy | Screen all pregnant patients at the first prenatal visit

Retets at 28 weeks' gestation and at delivery if at increased risk due to local syphilis prevalence or personal risk( substance use, STIs, multiple partners, a new partner, partners with STIs)

| All pregnant patients should be screened for syphilis as early during pregnancy as possible  | Screen all pregnant patients at the first prenatal visit, followed by universal rescreening during the third trimester and at delivery

## Screening tests

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Screening tests recommended for syphilis include the following:[11]

### Screening non-treponemal tests

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* Venereal Disease Research Laboratory (VDRL)[12]
* Rapid Plasma Reagin(RPR)[13]

### Confirmatory treponemal tests

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* Fluorescent treponemal antibody absorbed (FTA-ABS)[12]
* Treponema pallidum particle agglutination (TPPA)[13]

## References

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1. ↑ 1.0 1.1 https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/syphilis-infection-in-nonpregnant-adults-and-adolescents?ds=1&s=syphilis Accessed on September 19, 2016
2. ↑ 2.0 2.1 2.2 http://www.cdc.gov/std/treatment/2010/specialpops.htm Accessed on September 19, 2016
3. ↑ 3.0 3.1 3.2 https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/syphilis-infection-in-pregnancy-screening?ds=1&s=syphilis Accessed on September 19, 2016
4. ↑ US Preventive Services Task Force (USPSTF). Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW; et al. (2016). "Screening for Syphilis Infection in Nonpregnant Adults and Adolescents: US Preventive Services Task Force Recommendation Statement". JAMA. 315 (21): 2321–7. doi:10.1001/jama.2016.5824. PMID 27272583.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
5. ↑ 5.0 5.1 5.2 http://www.cdc.gov/std/tg2015/screening-recommendations.htm#modalIdString_CDCTable_2 Accessed on September 19, 2016
6. ↑ http://hivprevent.thelancet.com/content/guidelines-and-recommendations Accesed on September 19, 2016
7. ↑ "Screening for Syphilis Infection in Nonpregnant Adolescents and Adults: US Preventive Services Task Force Reaffirmation Recommendation Statement | Sexually Transmitted Infections | JAMA | JAMA Network".
8. ↑ "Screening for Syphilis in Pregnancy | ACOG".
9. ↑ "Screening for Syphilis Infection During Pregnancy: US Preventive Services Task Force Reaffirmation Recommendation Statement | Guidelines | JAMA | JAMA Network".
10. ↑ "Sexually Transmitted Infections Treatment Guidelines, 2021 | MMWR".
11. ↑ https://www.uspreventiveservicestaskforce.org/Page/Document/ClinicalSummaryFinal/syphilis-infection-in-pregnancy-screening Accessed on September 19, 2016
12. ↑ 12.0 12.1 Ratnam S (2005). "The laboratory diagnosis of syphilis". Can J Infect Dis Med Microbiol. 16 (1): 45–51. PMC 2095002. PMID 18159528.
13. ↑ 13.0 13.1 Larsen SA, Steiner BM, Rudolph AH (1995). "Laboratory diagnosis and interpretation of tests for syphilis". Clin Microbiol Rev. 8 (1): 1–21. PMC 172846. PMID 7704889.CS1 maint: Multiple names: authors list (link)

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