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Editorial |

Syphilis Screening in Neurology

Christina M. Marra, MD1,2
[+] Author Affiliations
1Department of Neurology, University of Washington, Seattle
2Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle
JAMA Neurol. 2016;73(8):926-927. doi:10.1001/jamaneurol.2016.1955.
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This Editorial discusses the US Preventive Services Task Force recommendation statement on screening for syphilis infection in nonpregnant adults and adolescents.

The US Preventive Services Task Force recommendation statement on syphilis screening in nonpregnant adults and adolescents1 recommends screening asymptomatic patients who are at increased risk for syphilis, in particular men who have sex with men as well as men and women living with human immunodeficiency virus, the groups in whom the incidence of syphilis in the United States is highest. The statement is less directive regarding the best method for and frequency of syphilis screening. The increased risk of false-positive results using the reverse sequence screening algorithm is noted, as is the potential benefit of screening every 3 months compared with annually in those at high risk for disease. While neurologists are unlikely to screen primary care patients for syphilis, the recommendation statement raises issues of relevance to us, which I frame as 3 questions.

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Figure.
Example of a Reverse Sequence Algorithm for Syphilis Screening

Automated serum treponemal tests include enzyme-linked and chemiluminescence immunoassays that measure IgG and IgM antibodies to recombinant Treponema pallidum subsp pallidum proteins. Alternative serum treponemal tests available in the United States include the fluorescent treponemal antibody absorption test and the T pallidum particle agglutination test, which measure IgG and IgM antibodies to antigens derived from whole T pallidum subsp pallidum organisms. RPR indicates rapid plasma reagin.

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