This statement summarizes the U Pre...

This statement summarizes the U Preventive Services Task Force (USPSTF) recommendations in succession screening for syphilis and the supporting scientific evidence, and updates the 1996 recommendations contained in the Guide to Clinical Preventive Services, other edition. (1) In 1996, the USPSTF commended routine screening for syphilis infection for all pregnant women and for somebodys at increased risk for infection. Since then, the USPSTF criteria to rate the puissance of the evidence have changed. (2) Therefore, this recommendation statement has been updated and revised based forward the current USPSTF methodology and rating of the force of the evidence. Explanations of the now passing task force ratings and of the solidity of overall evidence are given in Tables 1 and 2 respectively. The clean information on which this statement is based, including evidence tables and relations is available in the brief update (3) upon this topic on the USPSTF Web site (http://www.preventiveservices.ahrq.gov). The recommendation statement and brief update are also available in print from the Agency for Healthcare Research and Quality Publications Clearinghouse (1-800-358-9295; e-mail: ahrqpubs@ahrq.gov). The recommendation is also supported on the Web site of the National Guideline Clearinghouse (http://www.guideline.gov).

This recommendation statement was first published in Annals of Family Medicine (Ann Fam M 2004;2:362-5)

Summary of Recommendations

* The USPSTF violently recommends that physicians screen parts at increased risk for syphilis infection. A recommendation.

Although the USPSTF plant no new direct evidence that screening for syphilis infection leads to improved health issues in persons at increased risk (see Clinical Considerations), there is adequate evidence that screening standards can accurately detect syphilis infection and that antibiotics can help syphilis. Screening may result in potential harms (such as clinical evaluation of false-positive ends unnecessary anxiety to the patient, and harms of antibiotic use). The USPSTF gather s that the benefits of screening [i]role[/i]s at increased risk for syphilis infection substantially outweigh the potential harms.

* The USPSTF eagerly recommends that physicians screen all pregnant women for syphilis infection. A recommendation.

The USPSTF erect observational evidence that the universal screening of pregnant women decreases the proportion of infants with clinical manifestations of syphilis infection and those with positive serologies. The USPSTF terminates that the benefits of screening all pregnant women for syphilis infection substantially outweigh potential harms.

* The USPSTF commends against routine screening of asymptomatic bodily substances who are not at increased risk for syphilis infection. D recommendation.

Given the soft incidence of syphilis infection in the general population and the deducible low yield of such screening, the USPSTF deduces that potential harms of screening (i.e., opportunity sumptuousness false-positive test results, and labeling) in a low-incident population outweigh the benefits.

Clinical Considerations

* Populations at increased risk for syphilis infection (as determined at incidence rates) include men who have sex with men and engage in high-risk sexual behavior, commercial sex workers, individuals who exchange sex for put drugs intos and those in adult correctional facilities. There is no evidence to support an optimal screening common occurrence in these populations. Physicians should consider the characteristics of the communities they oblige in determining appropriate screening strategies. Prevalence of syphilis infection varies widely among communities and patient populations. For example, the prevalence of syphilis infection differs on region (the prevalence of infection is higher in the southern United States and in near metropolitan areas than it is in the rural parts as a whole) and by means of ethnicity (the prevalence of syphilis infection is higher in Hispanic and African-American populations than it is in the white population).

* ones diagnosed with other sexually transmitted diseases (STDs) (i.e., chlamydia, gonorrhea, genital herpes simplex, human papillomavirus, and human immu-nodeficiency virus [HIV]) may be more likely than others to engage in high-risk behavior, placing them at increased risk for syphilis; however, there is no evidence that supports the routine screening of living bodys diagnosed with other STDs for syphilis infection. Physicians should use clinical brains to individualize screening for syphilis infection based forward local prevalence and other risk factors (see above).

* Nontreponemal criterions commonly used for initial screening are the venereal disease research laboratory (VDRL) and rapid plasma reagin (RPR) followed by the agency of a confirmatory fluorescent treponemal antibody absorbed (FTA-ABS) or Treponema pallidum particle agglutination (TP-PA). The optimal screening interval in average-and high-risk someones has not been determined.

* All pregnant women should be trialed for syphilis infection at their first prenatal visit. For women in high-risk assign places tos repeat serologic testing may be necessary in the third trimester and at delivery. Follow-up serologic proofs should be obtained to document decline initially after treatment. These follow-up exhibitions should be performed using the same nontreponemal trial initially used to document infections (eg VDRL or RPR) to make secure comparability.