Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Screening for Syphilis in Nonpregnant Adults & Adolescents

JAMA; 2016 Jun 7; Bibbins-Domingo, Grossman, et al

Publish date:: June 21, 2016

The US Preventive Services Task Force (USPSTF) has issued an updated recommendation statement on screening for syphilis infections in nonpregnant adults and adolescents in which it strongly recommends screening individuals at increased risk for syphilis infection. The USPSTF makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms. Recommendations and findings include:

• Screening for syphilis infection in persons who are at increased risk for infection (A recommendation).

• Men who have had sex with men (MSM) and persons living with HIV have the highest risk for syphilis infection.

• Accurate screening tests, the most common being a combination of nontreponemal and treponemal antibody 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.

Citation: Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Screening for syphilis infection in nonpregnant adults and adolescents. JAMA. 2016;315(21)2321-2327. doi:10.1001/jama.2016.5824.

Commentary: From 2000 to 2014, the rate of syphilis in the US has increased by approximately 300%, to the current 20,000 cases of primary and secondary cases per year.¹ For comparisons sake, in 2014 there where 350,062 gonorrhea cases reported, and 1,441,789 chlamydial infections.¹ Syphilis occurs far more often in high-risk groups, with 61% of cases occurring in MSM. Additional factors that increase the risk of syphilis are HIV infection, a history of incarceration, history of commercial sex work, being a part of certain racial/ethnic groups including black, Hispanic , American Indian/Alaska Native, and Native Hawaiian/Pacific Islander, and being a male younger than 29 years. The recommendation for screening high-risk groups is driven by the increased prevalence of syphilis, the ability to identify high-risk groups, and the fact that early identification and treatment prevents progression to tertiary syphilis. —Neil Skolnik, MD

1. Centers for Disease Control and Prevention. 2014 Sexually Transmitted Diseases Surveillance. CDC Web site. http://www.cdc.gov/std/stats14/syphilis.htm. Accessed June 20, 2016.

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