What are the recommended screening tests for syphilis and gonorrhea?

Screening Tests for Syphilis and Gonorrhea

Syphilis Screening

For syphilis screening, use nontreponemal tests (RPR or VDRL) as the initial screening test, followed by confirmatory treponemal antibody testing (FTA-ABS or TPPA). 1

Testing Algorithm for Syphilis

• Initial screening: Perform either the Rapid Plasma Reagin (RPR) test or Venereal Disease Research Laboratory (VDRL) test as the first-line screening method 1
• Confirmatory testing: Follow positive nontreponemal tests with a treponemal-specific test such as fluorescent treponemal antibody absorbed (FTA-ABS) test or Treponema pallidum particle agglutination (TPPA) test 1
• Follow-up monitoring: Use the same nontreponemal test (RPR or VDRL) that was initially used to document infection when performing follow-up serologic tests after treatment, as this ensures comparable results and allows proper monitoring of antibody titer decline 1

Who Should Be Screened for Syphilis

• All pregnant women: Screen at the first prenatal visit, with repeat testing in the third trimester (28 weeks) and at delivery for high-risk women 1
• High-risk nonpregnant adults: Screen persons at increased risk, including those living in communities with primary or secondary syphilis rates >4.6 per 100,000 population 2, 3
• Men who have sex with men: Annual screening based on exposure history, with more frequent screening (every 3-6 months) for those at highest risk 4

Gonorrhea Screening

For gonorrhea screening, use nucleic acid amplification tests (NAATs), which have sensitivities of 86.1-100% and specificities of 97.1-100%. 5

Testing Approach for Gonorrhea

• Primary screening method: NAATs are the recommended diagnostic test due to their superior sensitivity and specificity compared to culture-based methods 5
• Specimen collection sites:
  • Genital specimens (urine, endocervical, or vaginal swabs) for routine screening 5
  • Consider extragenital screening at pharyngeal and rectal sites in women with risk factors for infection at these anatomic sites 2
• Site-specific testing for MSM: Screen pharyngeal, rectal, and urethral sites based on sexual practices (receptive oral, anal, or insertive intercourse respectively) 4

Who Should Be Screened for Gonorrhea

• Sexually active women ≤25 years: Annual screening for all women in this age group 4
• Older women with risk factors: Screen those with new or multiple sex partners, previous gonococcal infection, other STIs, inconsistent condom use, commercial sex work, or illicit drug use 4
• Pregnant women at increased risk: Screen high-risk pregnant women at first prenatal visit, with repeat testing in third trimester if risk continues 4
• Men who have sex with men: Annual screening at multiple anatomic sites based on sexual practices, with screening every 3-6 months for those at highest risk 4
• Incarcerated populations: Screen females ≤35 years upon intake in juvenile detention or jail facilities 4

Important Caveats

• Retest after treatment: All patients diagnosed with gonorrhea should be retested 3 months after treatment due to high reinfection rates, regardless of whether partners were treated 4
• Antimicrobial resistance: Be aware that antimicrobial resistance limits oral treatment options for gonorrhea, making accurate diagnosis and appropriate treatment selection critical 5
• Asymptomatic infections: Approximately 53-100% of extragenital gonorrhea infections are asymptomatic, emphasizing the importance of screening based on anatomic sites of exposure rather than symptoms alone 5