[Skip to Content]
[Skip to Content Landing]

Screening for Syphilis Infection in Nonpregnant Adolescents and AdultsUS Preventive Services Task Force Reaffirmation Recommendation Statement

To identify the key insights or developments described in this article
1 Credit CME
Abstract

Importance  Syphilis is a sexually transmitted infection that can progress through different stages (primary, secondary, latent, and tertiary) and cause serious health problems if left untreated. Reported cases of primary and secondary syphilis in the US increased from a record low of 2.1 cases per 100 000 population in 2000 and 2001 to 11.9 cases per 100 000 population in 2019. Men account for the majority of cases (83% of primary and secondary syphilis cases in 2019), and rates among women nearly tripled from 2015 to 2019.

Objective  To reaffirm its 2016 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a reaffirmation evidence update focusing on targeted key questions evaluating the performance of risk assessment tools and the benefits and harms of screening for syphilis in nonpregnant adolescents and adults.

Population  Asymptomatic, nonpregnant adolescents and adults who have ever been sexually active and are at increased risk for syphilis infection.

Evidence Assessment  Using a reaffirmation process, the USPSTF concludes with high certainty that there is a substantial net benefit of screening for syphilis infection in nonpregnant persons who are at increased risk for infection.

Recommendation  The USPSTF recommends screening for syphilis infection in persons who are at increased risk for infection. (A recommendation)

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Carol M. Mangione, MD, MSPH, David Geffen School of Medicine, University of California, Los Angeles, 10940 Wilshire Blvd, Ste 700, Los Angeles, CA 90024 (chair@uspstf.net).

Accepted for Publication: August 17, 2022.

The US Preventive Services Task Force (USPSTF) members: Carol M. Mangione, MD, MSPH; Michael J. Barry, MD; Wanda K. Nicholson, MD, MPH, MBA; Michael Cabana, MD, MA, MPH; David Chelmow, MD; Tumaini Rucker Coker, MD, MBA; Esa M. Davis, MD, MPH; Katrina E. Donahue, MD, MPH; Carlos Roberto Jaén, MD, PhD, MS; Martha Kubik, PhD, RN; Li Li, MD, PhD, MPH; Gbenga Ogedegbe, MD, MPH; Lori Pbert, PhD; John M. Ruiz, PhD; James Stevermer, MD, MSPH; John B. Wong, MD.

Affiliations of The US Preventive Services Task Force (USPSTF) members: University of California, Los Angeles (Mangione); Harvard Medical School, Boston, Massachusetts (Barry); University of North Carolina at Chapel Hill (Nicholson, Donahue); Albert Einstein College of Medicine, New York, New York (Cabana); Virginia Commonwealth University, Richmond (Chelmow); University of Washington, Seattle (Coker); University of Pittsburgh, Pittsburgh, Pennsylvania (Davis); The University of Texas Health Science Center, San Antonio (Jaén); George Mason University, Fairfax, Virginia (Kubik); University of Virginia, Charlottesville (Li); New York University, New York, New York (Ogedegbe); University of Massachusetts Medical School, Worcester (Pbert); University of Arizona, Tucson (Ruiz); University of Missouri, Columbia (Stevermer); Tufts University School of Medicine, Boston, Massachusetts (Wong).

Author Contributions: Dr Mangione had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The USPSTF members contributed equally to the recommendation statement.

Conflict of Interest Disclosures: Authors followed the policy regarding conflicts of interest described at https://www.uspreventiveservicestaskforce.org/Page/Name/conflict-of-interest-disclosures. All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings.

Funding/Support: The USPSTF is an independent, voluntary body. The US Congress mandates that the Agency for Healthcare Research and Quality (AHRQ) support the operations of the USPSTF.

Role of the Funder/Sponsor: AHRQ staff assisted in the following: development and review of the research plan, commission of the systematic evidence review from an Evidence-based Practice Center, coordination of expert review and public comment of the draft evidence report and draft recommendation statement, and the writing and preparation of the final recommendation statement and its submission for publication. AHRQ staff had no role in the approval of the final recommendation statement or the decision to submit for publication.

Disclaimer: Recommendations made by the USPSTF are independent of the US government. They should not be construed as an official position of AHRQ or the US Department of Health and Human Services.

Additional Contributions: We thank Brandy Peaker, MD, MPH (AHRQ), who contributed to the writing of the manuscript, and Lisa Nicolella, MA (AHRQ), who assisted with coordination and editing.

Additional Information: The US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms. It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment. The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision-making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms. Published by JAMA®—Journal of the American Medical Association under arrangement with the Agency for Healthcare Research and Quality (AHRQ). ©2022 AMA and United States Government, as represented by the Secretary of the Department of Health and Human Services (HHS), by assignment from the members of the United States Preventive Services Task Force (USPSTF). All rights reserved.

References
1.
Centers for Disease Control and Prevention. Syphilis—CDC detailed fact sheet. Reviewed April 12, 2022. Accessed August 2, 2022. https://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm
2.
Harvard Health Publishing. Syphilis. Published March 19, 2019. Accessed August 2, 2022. https://www.health.harvard.edu/a_to_z/syphilis-a-to-z
3.
Centers for Disease Control and Prevention. Syphilis & MSM (men who have sex with men)—CDC fact sheet. Reviewed April 12, 2022. Accessed August 2, 2022. https://www.cdc.gov/std/syphilis/stdfact-msm-syphilis.htm
4.
Centers for Disease Control and Prevention.  Sexually Transmitted Disease Surveillance 2019. US Dept of Health and Human Services; 2021.
5.
de Voux  A , Kidd  S , Grey  JA ,  et al.  State-specific rates of primary and secondary syphilis among men who have sex with men—United States, 2015.   MMWR Morb Mortal Wkly Rep. 2017;66(13):349-354. doi:10.15585/mmwr.mm6613a1PubMedGoogle ScholarCrossref
6.
Tapp  J , Hudson  T .  Sexually transmitted infections prevalence in the United States and the relationship to social determinants of health.   Nurs Clin North Am. 2020;55(3):283-293. doi:10.1016/j.cnur.2020.05.001PubMedGoogle ScholarCrossref
7.
Newman  LM , Berman  SM .  Epidemiology of STD disparities in African American communities.   Sex Transm Dis. 2008;35(12)(suppl):S4-S12. doi:10.1097/OLQ.0b013e31818eb90ePubMedGoogle ScholarCrossref
8.
Centers for Disease Control and Prevention. STD health equity. Reviewed March 2, 2020. Accessed August 2, 2022. https://www.cdc.gov/std/health-disparities/default.htm
9.
Henninger  MH , Bean  SI , Lin  JS .  Screening for Syphilis Infection in Nonpregnant Adults and Adolescents: A Targeted Evidence Update for the US Preventive Services Task Force. Evidence Synthesis No. 218. Agency for Healthcare Research and Quality; 2022. AHRQ publication 22-05290-EF-1.
10.
Henninger  ML , Bean  SI , Lin  JS .  Screening for syphilis infection in nonpregnant adults and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.   JAMA. Published September 27, 2022. doi:10.1001/jama.2022.8612Google Scholar
11.
Curry  SJ , Krist  AH , Owens  DK ,  et al; US Preventive Services Task Force.  Screening for syphilis infection in pregnant women: US Preventive Services Task Force reaffirmation recommendation statement.   JAMA. 2018;320(9):911-917. doi:10.1001/jama.2018.11785PubMedGoogle ScholarCrossref
12.
Bibbins-Domingo  K , Grossman  DC , Curry  SJ ,  et al; US Preventive Services Task Force (USPSTF).  Screening for syphilis infection in nonpregnant adults and adolescents: US Preventive Services Task Force recommendation statement.   JAMA. 2016;315(21):2321-2327. doi:10.1001/jama.2016.5824PubMedGoogle ScholarCrossref
13.
US Preventive Services Task Force. US Preventive Services Task Force Procedure Manual. Updated May 2021. Accessed August 2, 2022. https://uspreventiveservicestaskforce.org/uspstf/procedure-manual
14.
Kidd  SE , Grey  JA , Torrone  EA , Weinstock  HS .  Increased methamphetamine, injection drug, and heroin use among women and heterosexual men with primary and secondary syphilis—United States, 2013–2017.   MMWR Morb Mortal Wkly Rep. 2019;68(6):144-148. doi:10.15585/mmwr.mm6806a4PubMedGoogle ScholarCrossref
15.
Centers for Disease Control and Prevention. Syphilis surveillance supplemental slides, 2015-2019. Reviewed August 19, 2021. Accessed August 2, 2022. https://www.cdc.gov/std/statistics/2019/syphilis/default.htm
16.
Workowski  KA , Bachmann  LH , Chan  PA ,  et al.  Sexually transmitted infections treatment guidelines, 2021.   MMWR Recomm Rep. 2021;70(4):1-187. doi:10.15585/mmwr.rr7004a1PubMedGoogle ScholarCrossref
17.
Centers for Disease Control and Prevention. Sexually transmitted diseases (STDs). Reviewed June 29, 2022. Accessed August 15, 2022. https://www.cdc.gov/std
18.
Henao-Martínez  AF , Johnson  SC .  Diagnostic tests for syphilis: new tests and new algorithms.   Neurol Clin Pract. 2014;4(2):114-122. doi:10.1212/01.CPJ.0000435752.17621.48PubMedGoogle ScholarCrossref
19.
Rhoads  DD , Genzen  JR , Bashleben  CP , Faix  JD , Ansari  MQ .  Prevalence of traditional and reverse-algorithm syphilis screening in laboratory practice: a survey of participants in the College of American Pathologists syphilis serology proficiency testing program.   Arch Pathol Lab Med. 2017;141(1):93-97. doi:10.5858/2016-0110-CPPubMedGoogle ScholarCrossref
20.
Ortiz  DA , Shukla  MR , Loeffelholz  MJ .  The traditional or reverse algorithm for diagnosis of syphilis: pros and cons.   Clin Infect Dis. 2020;71(suppl 1):S43-S51. doi:10.1093/cid/ciaa307PubMedGoogle ScholarCrossref
21.
Bristow  CC , Klausner  JD , Tran  A .  Clinical test performance of a rapid point-of-care syphilis treponemal antibody test: a systematic review and meta-analysis.   Clin Infect Dis. 2020;71(suppl 1):S52-S57. doi:10.1093/cid/ciaa350PubMedGoogle ScholarCrossref
22.
US Preventive Services Task Force.  Screening for hepatitis B virus infection in adolescents and adults: US Preventive Services Task Force recommendation statement.   JAMA. 2020;324(23):2415-2422. doi:10.1001/jama.2020.22980PubMedGoogle ScholarCrossref
23.
US Preventive Services Task Force.  Screening for hepatitis C virus infection in adolescents and adults: US Preventive Services Task Force recommendation statement.   JAMA. 2020;323(10):970-975. doi:10.1001/jama.2020.1123PubMedGoogle ScholarCrossref
24.
US Preventive Services Task Force.  Serologic screening for genital herpes infection: US Preventive Services Task Force recommendation statement.   JAMA. 2016;316(23):2525-2530. doi:10.1001/jama.2016.16776PubMedGoogle ScholarCrossref
25.
US Preventive Services Task Force.  Screening for HIV infection: US Preventive Services Task Force recommendation statement.   JAMA. 2019;321(23):2326-2336. doi:10.1001/jama.2019.6587PubMedGoogle ScholarCrossref
26.
US Preventive Services Task Force.  Screening for chlamydia and gonorrhea: US Preventive Services Task Force recommendation statement.   JAMA. 2021;326(10):949-956. doi:10.1001/jama.2021.14081PubMedGoogle ScholarCrossref
27.
US Preventive Services Task Force.  Behavioral counseling interventions to prevent sexually transmitted infections: US Preventive Services Task Force recommendation statement.   JAMA. 2020;324(7):674-681. doi:10.1001/jama.2020.13095PubMedGoogle ScholarCrossref
28.
Allan-Blitz  LT , Konda  KA , Vargas  SK ,  et al.  The development of an online risk calculator for the prediction of future syphilis among a high-risk cohort of men who have sex with men and transgender women in Lima, Peru.   Sex Health. 2018;15(3):261-268. doi:10.1071/SH17118PubMedGoogle ScholarCrossref
29.
Chow  EPF , Callander  D , Fairley  CK ,  et al; ACCESS Collaboration.  Increased syphilis testing of men who have sex with men: greater detection of asymptomatic early syphilis and relative reduction in secondary syphilis.   Clin Infect Dis. 2017;65(3):389-395. doi:10.1093/cid/cix326PubMedGoogle ScholarCrossref
30.
Reynolds  GL , Fisher  DG , Brocato  J , van Otterloo  L , Khahlil  K , Huckabay  L .  Stressful point-of-care rapid testing for human immunodeficiency virus, hepatitis C virus, and syphilis.   Int J STD AIDS. 2017;28(10):975-984. doi:10.1177/0956462416684460PubMedGoogle ScholarCrossref
31.
American College of Obstetricians and Gynecologists. Chlamydia, gonorrhea, and syphilis. Updated January 2021. Accessed August 2, 2022. https://www.acog.org/womens-health/faqs/chlamydia-gonorrhea-and-syphilis
32.
Aberg  JA , Gallant  JE , Ghanem  KG , Emmanuel  P , Zingman  BS , Horberg  MA ; Infectious Diseases Society of America.  Primary care guidelines for the management of persons infected with HIV: 2013 update by the HIV Medicine Association of the Infectious Diseases Society of America.   Clin Infect Dis. 2014;58(1):e1-e34. doi:10.1093/cid/cit665PubMedGoogle ScholarCrossref
33.
American Academy of Family Physicians. Clinical Preventive Service Recommendation: syphilis. Accessed August 2, 2022. https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/syphilis.html
34.
American Academy of Family Physicians. Screening for Sexually Transmitted Infections Practice Manual. Published 2019. Accessed August 2, 2022. https://www.aafp.org/dam/AAFP/documents/patient_care/sti/hops19-sti-manual.pdf
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Close
Close

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close