Context-Appropriate Interventions to Prevent Syphilis: A Narrative Review

Abstract

Background: The success of an intervention to prevent syphilis will depend on the context and the goal of the intervention. To help programs choose interventions, we reviewed major changes in context and types of interventions that may be effective.

Methods: We reviewed the literature on the changing context of syphilis in the United States and interventions to prevent syphilis, focusing on articles that included evidence of effectiveness.

Results: Populations acquiring syphilis are constantly changing. Currently, incidence is very high among men who have sex with men (MSM). Among adults, late disease caused by syphilis has become rare. Congenital syphilis incidence has been low but is increasing, and morbidity and mortality remain high when babies are infected. Congenital syphilis now causes more deaths than syphilis among adults.Routine screening of MSM can identify and treat infections before they progress to disease (secondary prevention). Screening rates are highest when done as part of routine standing orders. Partner notification effectiveness has decreased, partly because many partners are anonymous. Most congenital syphilis can be prevented by screening pregnant women; it has been eliminated in areas where intense primary prevention efforts eliminated syphilis among women.

Conclusions: So far, no program has stopped the increasing rates of infection among MSM, but secondary prevention efforts have prevented most disability. Congenital syphilis is increasing, and can be decreased by screening pregnant women and stopped by intensive efforts to prevent infection among women.

Figure 1.

Primary and secondary syphilis: estimated annual rate per 100,000 population by sex and sex of sex partner, United States, 1963–2016. MSM: men who had sex with men. MSW: men who had sex with women only. Estimated using modified Heffelfinger M:F rate ratio of 1.1236, assuming no MSM had syphilis in 1994, and estimating 3.9% of men are MSM

Figure 2.

Reported primary and secondary syphilis among women and congenital syphilis by year of birth, United States, 1995–2016.

Text box 1.

Steps for implementing a context appropriate intervention for syphilis.