Frequent Syphilis Screening Necessary for High-Risk Populations

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High-risk screening populations include both MSM and people with HIV.
High-risk screening populations include both MSM and people with HIV.
This article is part of Infectious Disease Advisor's coverage of IDWeek 2017™, which took place in San Diego, CA. Our staff will be reporting on the latest breaking research and clinical advances in infectious diseases. Check back regularly for highlights from IDWeek 2017.

Patients at high risk for syphilis should receive screening every 3 months to prevent symptomatic syphilis or disease progression, according to research presented at IDWeek 2017, held from October 4-8 in San Diego, California.

Kristin Carr, MD, of the Loma Linda University Medical Center, and colleagues, conducted a retrospective chart review of patients who were seen at the Jerry L. Pettis Memorial VA Medical Center HIV Clinic between 2002 and 2016. Researchers identified 155 cases of syphilis diagnosed in 126 clinic patients (81% men who have sex with men; 71% white).

Between 2002 and 2004, 62.5% of patients were symptomatic at the time of diagnosis. Following a change in screening guidance from once a year to every 3 to 6 months, only 41.6% of patients had symptomatic syphilis infection. Among patients in whom syphilis developed, 69% had a history of prior infection; 54.8% had a viral load <50 copies/mL, and 57.1% had CD4 counts >400. Investigators noted 27 cases of neurosyphilis, 33% of which had ocular involvement. Of these patients, 19% had a rapid plasma regain test in 3 months, and 31% had not had a rapid plasma regain test in 6 months.

“This study showed a significant decrease in the amount of symptomatic syphilis with every 3-month screening compared to yearly screening,” Dr Carr and colleagues concluded. “This is important for preventing progression to neurosyphilis, especially ocular involvement, given a large portion of patients develop disease within 3 to 6 months.”

Dr Carr and colleagues emphasized that to prevent associated morbidity, screening in high-risk populations, especially men with HIV who have sex with men, should occur every 3 months. 


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Reference

Carr K, Mu A, Fajilan A, et al. Earlier detection of latent syphilis: every 3 month screening with MSM and HIV. Presented at: IDWeek 2017; October 4-8, 2017; San Diego, CA. Abstract 2255.

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