Syphilis screening
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Syphilis screening tests, such as the rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL) tests are cheap and fast but not completely specific, as many other conditions can cause a positive result.
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 (A recommendation).[1][2]
- Routine screening of adolescents who are asymptomatic for syphilis is not recommended [3]
Pregnant women
- At first prenatal visit[4]
- Retest at early third trimester and delivery if high risk [5]
- High risk population which require frequent screening includes:
- 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
- Anually for sexually active MSM[4]
- Every 3 to 6 months if increased risk
Women who have sex with women
- Routine screening is recommended[3]
Persons with HIV
- At first HIV evaluation for sexually active individuals[4][6][7]
- Annually after first evaluation
- More frequent testing for individuals who are at increased risk or are residing in highly prevalent area for syphilis
Screening tests
Screening tests recommended for syphilis include the following:[8]
Non treponemal tests
Initial screening tests:
- Venereal Disease Research Laboratory (VDRL)
- Rapid Plasma Reagin (RPR)
Confirmatory treponemal tests
- Fluorescent treponemal antibody absorbed (FTA-ABS)
- Treponema pallidum particle agglutination (TPPA)
- The requirement to test for syphilis has been challenged due to the vast improvements in HIV testing.
- 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.
US Preventive Services Task Force (USPSTF) Recommendation [9]
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Grade A recommendation1. Screen all pregnant women for syphilis infection. |
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References
- ↑ 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.
- ↑ https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/syphilis-infection-in-nonpregnant-adults-and-adolescents?ds=1&s=syphilis Accessed on September 19, 2016
- ↑ 3.0 3.1 http://www.cdc.gov/std/treatment/2010/specialpops.htm Accessed on September 19, 2016
- ↑ 4.0 4.1 4.2 http://www.cdc.gov/std/tg2015/screening-recommendations.htm#modalIdString_CDCTable_2 Accessed on September 19, 2016
- ↑ https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/syphilis-infection-in-pregnancy-screening?ds=1&s=syphilis Accessed on September 19, 2016
- ↑ More, Read. "Guidelines and recommendations." (1999).
- ↑ http://hivprevent.thelancet.com/content/guidelines-and-recommendations Accesed on September 19, 2016
- ↑ https://www.uspreventiveservicestaskforce.org/Page/Document/ClinicalSummaryFinal/syphilis-infection-in-pregnancy-screening Accessed on September 19, 2016
- ↑ "National Guideline Clearinghouse | Screening for syphilis infection in pregnancy: U.S. Preventive Services Task Force reaffirmation recommendation statement". Retrieved 2012-12-18.