USPSTF reaffirms syphilis screening recommendation

Key takeaways

• Amid a long, steady increase in the incidence of syphilis, the United States Preventive Services Task Force has reaffirmed its 2016 recommendation to screen for those at increased risk for infection — a grade “A” recommendation.
• In 2000 and 2001, there were 2.1 cases of syphilis per 100,000 people, but that number jumped to 15.8 per 100,000 in 2021, according to the USPSTF and CDC.

Citing an increase in the incidence of syphilis infections over the past 2 decades, the U.S. Preventive Services Task Force has reaffirmed its recommendation to screen those at increased risk for infection.

The grade A recommendation reaffirms the task force’s position stated in 2016 and applies to nonpregnant sexually active adolescents and adults who are at high risk, although the task force also suggested screening all pregnant people in a separate recommendation.

Katrina Donahue, MD, a task force member, said in a press release that it is “vital” that those at risk for syphilis are screened “so the infection can be treated before problems develop or worsen.” If left untreated, syphilis can harm the cardiovascular system, brain, nerves and eyes, according to the task force.

“In the face of rising rates of syphilis, primary care professionals have an important role in helping to keep their patients healthy,” Donahue said.

Syphilis rates hit a record low in 2000 but have been increasing over the last 20 years, according to task force. In 2000 and 2001, there were 2.1 cases per 100,000 people, but that number jumped to 11.9 cases per 100,000 in 2019.

A JAMA editorial that accompanied the recommendation statement cited CDC data from 2021 that showed an even higher rate — at 15.8 per 100,000.

“When deciding which persons to screen for syphilis, clinicians should consider the prevalence of infection in the communities they serve, as well as other sociodemographic and behavioral factors that may be associated with increased risk of syphilis infection,” according to task force.

There are also health disparities to consider, the task force said. Although most cases are attributed to men, rates among women tripled from 2015 to 2019. Syphilis rates are higher in people with a history of incarceration, sex work or military service; people with HIV or other sexually transmitted infections; and in men who have sex with men. In addition, syphilis rates among Hispanic/Latino, Native American/Alaska Native or Native Hawaiian/Pacific Islander, and Black populations are about five times higher than rates in white populations.

“These disparities are primarily driven by social conditions such as poverty, low education levels, and poor access to quality health care, which disproportionately affect communities of color and make it harder to maintain sexual health,” according to the task force.

The task force also called for more research to better understand what causes the imbalance and how to improve health equity.

“Health care professionals should be knowledgeable about a patient’s risk for syphilis infection based on both an individual- and community-level assessment,” Michael Barry, MD, task force chair, said in the release.

In the editorial accompanying the report, Susan A. Tuddenham, MD, MPH, an assistant professor of medicine at Johns Hopkins University, and Khalil G. Ghanem, MD, PhD, a professor of medicine and the deputy director of education at Johns Hopkins Bayview Medical Center, wrote that the new recommendation statement “is important,” but cautioned that “relying on existing approaches that depend on traditional clinician-driven, clinic-based testing will not curtail the epidemic.”

“Expanding access to screening through patient-initiated testing is a way forward. This will require improved diagnostics, as well as addressing issues related to regulatory requirements, costs, and public health reporting,” they wrote. “Funding should be prioritized for the development of novel syphilis diagnostics, just as there has been for development of syphilis vaccines, which are still many years from becoming a reality.”

“Failure to modernize screening strategies for syphilis will also mean failure to control this infection,” the editorial concluded.

References:

• CDC. Preliminary 2021 STD surveillance data. https://www.cdc.gov/std/statistics/2021/default.htm. Accessed Sept. 26, 2022.
• US Preventive Services Task Force (USPSTF). JAMA. 2022;doi:10.1001/jama.2022.15322.
• US Preventive Services Task Force (USPSTF). JAMA. 2022;doi:10.1001/jama.2022.15227.
• US Preventive Services Task Force (USPSTF). JAMA. 2022;doi:10.1001/jama.2022.8612.
• US Preventive Services Task Force (USPSTF). JAMA. 2016;doi:10.1001/jama.2016.5824.
• US Preventive Services Task Force (USPSTF). JAMA. 2018;doi:10.1001/jama.2018.11785.