Screening for syphilis in nonpregnant adolescents and adults : systematic review to update the 2004 U.S. Preventive Services Task Force recommendation / prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University ; investigators, Amy Cantor, Heidi D. Nelson, Monica Daeges, Miranda Pappas

BACKGROUND: In 2004, the U.S. Preventive Services Task Force recommended routine screening for syphilis infection in asymptomatic persons at increased risk of infection, and recommended against screening in those not at increased risk. PURPOSE: To update a prior systematic review on screening for syphilis infection in asymptomatic, nonpregnant adolescents and adults for the U.S. Preventive Services Task Force. DATA SOURCES: Cochrane Central Register of Controlled Trials (to March 2016) and Cochrane Database of Systematic Reviews (to March 2016), MEDLINE (January 2004 to March 2016), and reference lists. STUDY SELECTION: English-language trials and observational studies of screening effectiveness, test accuracy, and screening harms. DATA EXTRACTION: One investigator abstracted details about study design, patient population, setting, screening method, followup, and results. Two investigators independently applied prespecified criteria to rate study quality. Discrepancies were resolved through consensus. DATA SYNTHESIS: Four observational studies conducted outside the United States evaluated detection rates using specific screening intervals among men who have sex with men (MSM) or persons living with HIV. Higher rates of detection were reported for early syphilis in MSM living with HIV (8.1% vs. 3.1%; p=0.001), newly acquired syphilis in MSM living with HIV (7.3 cases [95% CI, 5.2 to 9.9] vs. 2.8 cases [95% CI, 1.8 to 4.0] per 1,000 patient-years; p<0.05); early latent syphilis in MSM (1.7% vs. 0.4%; p=0.008); and early syphilis in higher-risk MSM (53% vs. 16%; p=0.001) when screening every 3 months compared with 6 or 12 months. Three diagnostic accuracy studies found that treponemal or nontreponemal tests are accurate screening tests for syphilis in asymptomatic persons (sensitivity >85% and specificity >91% for nontreponemal and treponemal tests in most studies) but require confirmatory testing. Two studies of the accuracy of reverse sequence testing indicated that using an automated treponemal test for initial screening resulted in a higher rate of false-reactive tests compared with using the Rapid Plasma Reagin test as an initial test in a low prevalence U.S. population (0.6% vs. 0.0%; p=0.03) and a higher prevalence Canadian population (0.26% vs. 0.13%), but both methods also identified additional positive tests that would not have been identified using conventional methods. LIMITATIONS: No studies addressed the effectiveness of screening, the effectiveness of risk assessment instruments, or the adverse effects of screening. No studies were specifically conducted in adolescents. Only screening tests and methods cleared by the U.S. Food and Drug Administration for current clinical practice were included to determine diagnostic accuracy. CONCLUSIONS: Observational data from four studies demonstrate improved detection of syphilis infection among MSM or men living with HIV who are screened every 3 months compared with 6 or 12 months. Screening with treponemal or nontreponemal tests is accurate for detecting syphilis in asymptomatic persons but requires confirmatory testing. Further research is needed to understand the impact of screening for syphilis on clinical outcomes; effective screening strategies, including reverse sequence screening, in various patient populations; and harms of screening..

Medienart:	E-Book

Erscheinungsjahr:	June 2016
Erschienen:	Rockville, MD: Agency for Healthcare Research and Quality ; June 2016

Reihe:	Evidence syntheses - number 136 AHRQ publication - no. 14-05213-EF-1

Sprache:	Englisch

Beteiligte Personen:	Cantor, Amy [VerfasserIn] Nelson, Heidi D. [VerfasserIn] Daeges, Monica [VerfasserIn] Pappas, Miranda [VerfasserIn]

Links:	www.ncbi.nlm.nih.gov [teilw. kostenfrei]

Themen:	Adolescent Adult Guidelines as Topic Mass Screening Syphilis Systematic Review U.S. Preventive Services Task Force United States

Anmerkungen:	Includes bibliographical references. - Description based on online resource; title from PDF title page (July 31, 2016)

Umfang:	1 online resource (1 PDF file (vi, 82 pages))

Förderinstitution / Projekttitel:

PPN (Katalog-ID):	1773206044