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JAMA Patient Page
June 7, 2016

Screening for Syphilis

JAMA. 2016;315(21):2367. doi:10.1001/jama.2016.7188

The US Preventive Services Task Force (USPSTF) has published updated recommendations on screening for syphilis infection in adults and adolescents.

What Is Syphilis?

Syphilis is a sexually transmitted infection caused by bacteria called Treponema pallidum. There are different stages of syphilis, and each stage has different symptoms. Primary syphilis occurs 2 or 3 weeks after infection, with symptoms of 1 or more small, painless ulcers (chancres) in areas of sexual contact. Because the chancres are painless and go away on their own, many people do not seek treatment. This can lead to secondary syphilis a few weeks or months later. Symptoms of secondary syphilis include flulike symptoms, fever, a widespread rash, and swollen lymph nodes. If still left untreated, these symptoms disappear and a period of latent syphilis follows that can last for several years and during which people may have no symptoms. Symptoms of tertiary syphilis (or late-stage syphilis) can arise, which include serious damage to many organs such as the heart, brain, spinal cord, and bones.

The risk of syphilis transmission is highest during the first year of infection, which can include primary, secondary, and early latent syphilis. Syphilis can be prevented by practicing safe sex and is treatable at any stage with antibiotics (usually penicillin). Syphilis can also be transmitted at any stage from a pregnant woman to her fetus.

What Tests Are Used to Screen for Syphilis?

Screening for syphilis is done by blood tests. There are 2 types of blood tests used, usually in a 2-step process, with the second test acting as a confirmatory test if the first test result is positive. These tests look for the presence of antibodies in the blood against syphilis, not the syphilis bacteria.

What Is the Patient Population Under Consideration for Screening for Syphilis?

The USPSTF recommendation applies to nonpregnant adults and adolescents who are at increased risk of syphilis infection and who do not have any symptoms of infection. There is no precise definition of what “increased risk” means because there is much variation among different communities and regions within the United States. In general, people with HIV and men who have sex with men are considered to be at high risk. Syphilis screening in pregnant women is discussed in a separate USPSTF recommendation.

What Are the Potential Benefits and Harms of Screening for Syphilis?

There is convincing evidence that the benefits of early detection and treatment of syphilis are substantial, including curing the infection, preventing transmission to others, and preventing late-stage disease. No studies have directly looked at harms of screening, but they are likely to be small, including false-positive results that lead to further testing, anxiety, and possible stigma. Harms of treatment, such as allergic reactions to penicillin, are also small.

How Strong Is the Recommendation to Screen for Syphilis?

Given the current evidence, the USPSTF has concluded with high certainty that the benefits of screening for syphilis in people who are at increased risk of infection substantially outweigh the potential harms. The optimal frequency for screening is currently not well established.

Bottom Line: Current Recommendation for Screening for Syphilis

The USPSTF recommends screening for syphilis in all nonpregnant adults and adolescents at increased risk of infection (called an “A” statement).

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For More Information

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at www.jama.com. Spanish translations are available in the supplemental content tab. A Patient Page describing the US Preventive Services Task Force was published in the April 26, 2016, issue of JAMA.

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The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Source: US Preventive Services Task Force. Screening for syphilis infection in nonpregnant adults and adolescents: US Preventive Services Task Force recommendation statement. JAMA. doi:10.1001/jama.2016.5824.

Topic: Preventive Medicine

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