USPSTF Recommends Screening for Syphilis in High-Risk Patients

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

The U.S. Preventive Services Task Force recommends that clinicians screen high-risk nonpregnant adults and adolescents for syphilis. The grade A recommendation, published in JAMA, is consistent with the group's 2004 guidance but offers updated information on risk factors, prevalence, and screening tests.

Patients with elevated risk include men who have sex with men, people with HIV, patients with a history of incarceration or commercial sex work, and men under age 29. Race/ethnicity and geography also play a role in determining risk. For instance, syphilis prevalence rates are highest among black, Hispanic, and American Indian/Alaska Native people. In addition, areas in the southern and western U.S., as well as urban settings, generally have higher prevalence rates than other regions.

The authors note that in 2014, the number of U.S. syphilis cases was up 12% from the previous year.

Editorialists conclude: "Although imperfect, serologic syphilis screening is highly sensitive and specific in high-prevalence populations, is inexpensive and technically simple, and has minimal potential for harm. These factors argue for much more widespread and comprehensive screening of groups at high risk for syphilis."