Structured Abstract

Contents

• 1. Introduction
  • Purpose and Previous U.S. Preventive Services Task Force Recommendation
  • Condition Definition
  • Prevalence
  • Etiology, Natural History, and Burden of Disease
  • Risk Factors
  • Rationale for Screening and Screening Strategies
  • Interventions and Treatment
  • Current Clinical Practice
  • Recommendations of Other Groups
• 2. Methods
  • Key Questions and Analytic Framework
  • Search Strategies
  • Study Selection
  • Data Abstraction and Quality Rating
  • Data Synthesis
  • External Review
  • Response to Public Comment
• 3. Results
  • Key Question 1 What Is the Effectiveness of Screening for Syphilis in Reducing Complications of the Disease and Transmission or Acquisition of Other STIs in Asymptomatic, Nonpregnant, Sexually Active Adults and Adolescents? What Is the Effectiveness of Specific Screening Intervals and Screening Among Population Subgroups?
  • Key Question 2 What Is the Effectiveness of Risk Assessment Instruments or Other Risk Stratification Methods for Identifying Individuals Who Are at Increased Risk for Syphilis?
  • Key Question 3 What Is the Accuracy of Currently Used Screening Tests and Strategies for Detecting Syphilis Infection?
  • Key Question 4 What Are the Harms of Screening?
  • Contextual Question 1 Which Population Subgroups, Including MSM, Are at Highest Risk for Incident Syphilis Infection?
  • Contextual Question 2 Which Population Subgroups Are at Highest Risk for Syphilis-Related Morbidity and Mortality?
• 4. Discussion
  • Summary of Review Findings
  • Limitations
  • Emerging Issues and Next Steps
  • Relevance for Priority Populations
  • Future Research
  • Conclusions
• References
• Appendix A Terminology
• Appendix B Detailed Methods
• Appendix C Evidence and Quality Tables

Acknowledgements: The authors acknowledge Andrew Hamilton, MLS, MS, for conducting literature searches and Spencer Dandy, BS, for assistance with drafting this report at the Oregon Health & Science University. The authors also thank AHRQ Medical Officers Tina Fan, MD, MPH, and Tess Miller, DrPH, as well as current and former members of the U.S. Preventive Services Task Force who contributed to topic deliberations.

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services¹. Contract No. HHSA-290-2012-00015-I, Task Order No. 4. Prepared by: Pacific Northwest Evidence-Based Practice Center²

Suggested citation:

Cantor A, Nelson HD, Daeges M, Pappas M. Screening for Syphilis in Nonpregnant Adolescents and Adults: Systematic Review to Update the 2004 U.S. Preventive Services Task Force Recommendation. Evidence Synthesis No. 136. AHRQ Publication No. 14-05213-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2016.

This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA-290-2012-00015-I). The investigators involved have declared no conflicts of interest with objectively conducting this research. The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information (i.e., in the context of available resources and circumstances presented by individual patients).

The final report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.

1

5600 Fishers Lane, Rockville, MD 20857; www​.ahrq.gov

2

Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239; www​.ohsu.edu/epc