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__NOTOC__
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{{Syphilis}}
{{Syphilis}}
==Overview==
==Overview==  
Syphilis screening tests, such as the [[Rapid Plasma Reagin]] (RPR) and [[Venereal Disease Research Laboratory test|Venereal Disease Research Laboratory]] (VDRL) tests are cheap and fast but not completely [[specificity (tests)|specific]], as many other conditions can cause a positive result.
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 [[Human Immunodeficiency Virus (HIV)|HIV]] positive individuals.<ref name= sypilis>https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/syphilis-infection-in-nonpregnant-adults-and-adolescents?ds=1&s=syphilis Accessed on September 19, 2016</ref> Routine screening of adolescents who are asymptomatic for syphilis is not recommended.<ref name=cdc5>http://www.cdc.gov/std/treatment/2010/specialpops.htm Accessed on September 19, 2016</ref><ref name=USPTF4> https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/syphilis-infection-in-pregnancy-screening?ds=1&s=syphilis Accessed on September 19, 2016</ref>


==Screening==
==Screening==
*Syphilis screening tests, such as the [[rapid plasma reagin]] (RPR) and [[Venereal Disease Research Laboratory test|venereal disease research laboratory]] (VDRL) tests are cheap and fast but not completely [[specificity (tests)|specific]], as many other conditions can cause a positive result.
[[Screening]] guidelines for syphilis are:
===Non-pregnant adults and adolescents (age 15-65)===
*All individuals who are at increased risk for syphilis should be screened for syphilis [[United states preventive services task force recommendations scheme#USPSTF Grade Definitions|Grade A recommendation]].<ref name= sypilis>https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/syphilis-infection-in-nonpregnant-adults-and-adolescents?ds=1&s=syphilis Accessed on September 19, 2016</ref><ref name="pmid27272583">{{cite journal| author=US Preventive Services Task Force (USPSTF). Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW et al.| title=Screening for Syphilis Infection in Nonpregnant Adults and Adolescents: US Preventive Services Task Force Recommendation Statement. | journal=JAMA | year= 2016 | volume= 315 | issue= 21 | pages= 2321-7 | pmid=27272583 | doi=10.1001/jama.2016.5824 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27272583  }} </ref>
*Routine screening of adolescents who are asymptomatic for syphilis is not recommended.<ref name=cdc5>http://www.cdc.gov/std/treatment/2010/specialpops.htm Accessed on September 19, 2016</ref>


*These tests are routinely used to screen [[Blood Donation|blood donors]]. Notably, the spirochete that causes syphilis does not survive the conditions used to store blood and the number of transfusion transmitted cases of syphilis is minuscule, but the test is used to identify donors that might have contracted [[HIV]] from high risk sexual activity.
===Pregnant women===
*At first [[Prenatal|prenatal visit]]<ref name=CDC4>http://www.cdc.gov/std/tg2015/screening-recommendations.htm#modalIdString_CDCTable_2 Accessed on September 19, 2016</ref>
*Retest at early [[third trimester]] and delivery if high risk<ref name=USPTF4> https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/syphilis-infection-in-pregnancy-screening?ds=1&s=syphilis Accessed on September 19, 2016</ref>
*High risk populations which require frequent screening include:<ref name=USPTF4> https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/syphilis-infection-in-pregnancy-screening?ds=1&s=syphilis Accessed on September 19, 2016</ref>
:*Uninsured women
:*Women living in poverty
:*Sex workers
:*[[Drug abuse|Illicit drug users]]
:*Presence of other sexually transmitted diseases ([[Sexually transmitted disease|STDs]])
:*Other women living in communities with high syphilis morbidity


*The requirement to test for syphilis has been challenged due to the vast improvements in [[HIV testing]].
===Men who have sex with men===
*Annually for sexually active men who have sex with men<ref name=CDC4>http://www.cdc.gov/std/tg2015/screening-recommendations.htm#modalIdString_CDCTable_2 Accessed on September 19, 2016</ref>
*Every 3 to 6 months if increased risk


*False positives on the rapid tests can be seen in viral infections ([[Epstein-Barr]], [[hepatitis]], [[varicella]], [[measles]]), [[lymphoma]], [[tuberculosis]], [[malaria]], [[endocarditis]], [[connective tissue disease]], [[pregnancy]], intravenous drug abuse, or contamination. As a result, these two screening tests should always be followed up by a more specific treponemal test.
===Women who have sex with women===
*Routine screening is recommended<ref name=cdc5>http://www.cdc.gov/std/treatment/2010/specialpops.htm Accessed on September 19, 2016</ref>


==US Preventive Services Task Force (USPSTF) Recommendation <ref>[http://www.guideline.gov/content.aspx?id=14559&search=syphilis]</ref>==
===HIV positive individuals===
{{cquote|
*At first [[HIV]] evaluation for sexually active individuals<ref name=CDC4>http://www.cdc.gov/std/tg2015/screening-recommendations.htm#modalIdString_CDCTable_2 Accessed on September 19, 2016</ref><ref name=lancet> http://hivprevent.thelancet.com/content/guidelines-and-recommendations Accesed on September 19, 2016</ref>
=====[[United states preventive services task force recommendations scheme#USPSTF Grade Definitions|Grade A recommendation]]=====
*Annually after first evaluation
1. Screen all pregnant women for syphilis infection.}}
*More frequent testing for individuals who are at increased risk or are residing in highly prevalent areas of syphilis
 
==Screening tests==
Screening tests recommended for syphilis include the following:<ref name= UPTFS2>https://www.uspreventiveservicestaskforce.org/Page/Document/ClinicalSummaryFinal/syphilis-infection-in-pregnancy-screening Accessed on September 19, 2016</ref>
 
===Screening non-treponemal tests===
*[[Venereal Disease Research Laboratory]] ([[VDRL]])<ref name="pmid18159528">{{cite journal| author=Ratnam S| title=The laboratory diagnosis of syphilis. | journal=Can J Infect Dis Med Microbiol | year= 2005 | volume= 16 | issue= 1 | pages= 45-51 | pmid=18159528 | doi= | pmc=2095002 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18159528  }} </ref>
*[[Rapid Plasma Reagin]]([[RPR]])<ref name="pmid7704889">{{cite journal| author=Larsen SA, Steiner BM, Rudolph AH| title=Laboratory diagnosis and interpretation of tests for syphilis. | journal=Clin Microbiol Rev | year= 1995 | volume= 8 | issue= 1 | pages= 1-21 | pmid=7704889 | doi= | pmc=172846 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7704889  }} </ref>
 
===Confirmatory treponemal tests===
*[[Fluorescent treponemal antibody absorbed]] ([[FTA-ABS]])<ref name="pmid18159528">{{cite journal| author=Ratnam S| title=The laboratory diagnosis of syphilis. | journal=Can J Infect Dis Med Microbiol | year= 2005 | volume= 16 | issue= 1 | pages= 45-51 | pmid=18159528 | doi= | pmc=2095002 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18159528  }} </ref>
*''[[Treponema pallidum]]'' particle agglutination ([[Treponema pallidum hemagglutination assay (TPHA) test|TPPA]])<ref name="pmid7704889">{{cite journal| author=Larsen SA, Steiner BM, Rudolph AH| title=Laboratory diagnosis and interpretation of tests for syphilis. | journal=Clin Microbiol Rev | year= 1995 | volume= 8 | issue= 1 | pages= 1-21 | pmid=7704889 | doi= | pmc=172846 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7704889  }} </ref>


==References==
==References==
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Latest revision as of 00:23, 30 July 2020

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

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Overview

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

Screening guidelines for syphilis are:

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

  • 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

  • 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

  • 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

  • Routine screening is recommended[2]

HIV positive individuals

  • 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

Screening tests

Screening tests recommended for syphilis include the following:[7]

Screening non-treponemal tests

Confirmatory treponemal tests

References

  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.
  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. ↑ https://www.uspreventiveservicestaskforce.org/Page/Document/ClinicalSummaryFinal/syphilis-infection-in-pregnancy-screening Accessed on September 19, 2016
  8. ↑ 8.0 8.1 Ratnam S (2005). "The laboratory diagnosis of syphilis". Can J Infect Dis Med Microbiol. 16 (1): 45–51. PMC 2095002. PMID 18159528.
  9. ↑ 9.0 9.1 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.


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