SYPHILIS – WHAT IS THE BEST METHOD OF SCREENING?

Objective: Compare treponemal tests (TT) to non-treponemal tests (NTT) in the initial syphilis screening, metric comparison includes sensitivities tests and cost effectiveness. Method: We conducted a research in MEDLINE and evidence-based medicine websites of meta-analyzes (MA), systematic reviews (SR), original studies (OS) and clinical practice guidelines (CPG), published between January/2008 and January/2016 in Portuguese, English, Spanish and French languages and using the MeSH terms: syphilis serodiagnosis. For assessment of levels of evidence, we adopted the Oxford Centre for Evidence-Based Medicine (CEBM) scale. Results and Conclusions: Of 429 articles obtained, seven met the inclusion criteria (four CPG and three OS). CPG differ in their actual tests screening recommendations. The US Preventive Services Task Force recommend initial screening for syphilis using NTT, the International Union against Sexually Transmitted Infections and the British Society for Sexual Health and HIV recommends initial screening for syphilis using TT. The Public Health Agency of Canada recommend screening for Syphilis involved the use of NTT, however, in patients with suspected primary syphilis or late latent syphilis it is then appropriate to add a TT to the initial screen. Of OS, one recommend initial screening for syphilis using TT and two recommends NTT. The evidence found is insufficient to elect a preferable method for initial syphilis screening in Portugal. TT are more sensitive and specific, however, in low-prevalence populations, these tests present more false-positive. In these same populations, NTT was more cost-effective. Thus, more studies are required to permit choosing the best method for initial syphilis screening.