"Reason for Testing" Among Patients Found to Have Syphilis

Background:
In Minnesota, effort has been made to routinize syphilis screening among men who have sex with men (MSM), the population most at risk, through clinic protocols and outreach testing initiatives. Beginning in 2006 the Minnesota Department of Health began collecting data regarding “reason for testing,” allowing examination of the effectiveness of this effort.

Objective:
To assess why patients who were found to have untreated syphilis were tested and assess the effectiveness of routine screening.

Method:
Beginning in 2006, the Minnesota Department of Health Syphilis Laboratory Surveillance Coordinator collected “reason for testing” data from clinics when following-up case reports. The reported reason was assigned into nine possible categories such as “STD screening,” “prenatal” screening, and “symptoms currently.” These data were compared for staging and by gender.

Result:
Overall, “STD screening” was the most common reason for testing (39%), closely followed by “symptoms currently” (36%).
For men, “STD screening” and “symptoms currently” were reported equally (41%). However, looking at only P/S cases, 94% were tested due to symptoms and only 1%, or one case, was attributed to “STD screening.” Meanwhile, “STD screening” was the most common reason for testing for early-latent (42%) and late-latent cases (77%).
Among women, while “prenatal” screening was the most common reason for testing (43%) followed by “STD screening” (32%), none of these cases were P/S. Meanwhile, 19 cases were identified through “prenatal” screening.

Conclusion:
Routine screening is effective in identifying untreated syphilis, and prenatal screening has likely been effective in preventing cases of congenital syphilis. Screening, however, is not effective in identifying P/S syphilis.

Implications:
Prenatal screening of pregnant women appears to be an important tool in preventing congenital syphilis. However, screening programs and protocols targeting MSM, while effective in identifying untreated syphilis, appears to be ineffective in identifying P/S cases.