Screening for Syphilis Infection in Nonpregnant Adolescents and Adults

Abstract

ImportanceSyphilis is a sexually transmitted infection that can progress through different stages (primary, secondary, latent, and tertiary) and cause serious health problems if left untreated. Reported cases of primary and secondary syphilis in the US increased from a record low of 2.1 cases per 100 000 population in 2000 and 2001 to 11.9 cases per 100 000 population in 2019. Men account for the majority of cases (83% of primary and secondary syphilis cases in 2019), and rates among women nearly tripled from 2015 to 2019.ObjectiveTo reaffirm its 2016 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a reaffirmation evidence update focusing on targeted key questions evaluating the performance of risk assessment tools and the benefits and harms of screening for syphilis in nonpregnant adolescents and adults.PopulationAsymptomatic, nonpregnant adolescents and adults who have ever been sexually active and are at increased risk for syphilis infection.Evidence AssessmentUsing a reaffirmation process, the USPSTF concludes with high certainty that there is a substantial net benefit of screening for syphilis infection in nonpregnant persons who are at increased risk for infection.RecommendationThe USPSTF recommends screening for syphilis infection in persons who are at increased risk for infection. (A recommendation)

Syphilis Infections, Reinfections and Serological Response in a Large Italian Sexually Transmitted Disease Centre: A Monocentric Retrospective Study

“…The extent of sexually risky behaviour over time is the strongest risk factor for repeated syphilis episodes when compared to other indicators (antiretroviral regimen or immunological status) [26]. The identification of at-risk adults and adolescents is crucial to improve syphilis screening strategies, as recommended by the latest USPSTF (US Preventive Services Task Force) statements [27][28][29]. While the interpretation of the indirect methods for syphilis diagnosis is relatively straightforward in patients without a prior history of syphilis, it becomes more complex in the case of reinfections, as treponemal antibodies mostly remain positive for their entire life cycle, tests lack sensitivity in early infection (as well as when patients are contagious), and non-treponemal titres often lead to difficult-to-interpret serological responses after treatment [29].…”

The Syphilis Point of Care Rapid Testing and Immediate Treatment Evaluation (SPRITE) Study

“…Many public health agencies are interested in how frontline public health nurses can implement POC tests. Underserved populations, including those who are un(der)housed, street-involved, or use injection drugs, are known to be disproportionately affected by syphilis (8, 12, 13). Providing accessible STBBI services to these individuals improves individual-level health outcomes and prevents ongoing transmission.…”

“…Underserved communities including people who use drugs, and un(der)housed individuals are known to be disproportionately affected by syphilis (8, 12, 13). In 2022, the age-standardized rate of infectious syphilis among females 15 to 44 years of age was almost three times higher in neighbourhoods with the most materially related marginalization, compared to those with the least materially related marginalization (8).…”

Evaluation of rapid diagnostic test kits for detection of Treponema pallidum antibody

“…Syphilis, a well-known sexually transmitted infection, occurs due to the bacterium Treponema pallidum (TP) [ 1 ]. Despite advancements in detection methods and affordable, effective treatments, syphilis continues to be a significant health issue.…”