Press Coverage of MMWR on Syphilis

Press coverage of the CDC MMWR from several media organizations has focused on the fact that approximately 18 percent of positive results from the newer syphilis antibody test (EIA/CIA) were not verified when they were retested with older syphilis tests (RPR, TP-PA). The coverage asserted that as a result of these positive results patients may have been falsely diagnosed and "may have been given unnecessary treatment."

There are two problems with this assertion. First, the current report does not document whether or not treatment was provided. Second, in those cases where treatment was provided, it may have been justified based on sexual risk and findings on clinical evaluation. It is also important to note that syphilis is not diagnosed on the basis of a single blood test. Many labs routinely will do additional testing when the first test is positive, without notifying the patient. Doctors diagnose syphilis after considering at least two syphilis tests, the patient's history, the physical exam, and a review of past syphilis test results. The MMWR analysis, while important, does not allow us to conclude that the newer tests led to inaccurate syphilis diagnoses or inappropriate treatment.

Key messages for syphilis control efforts remain the same:

• Patients at high risk should continue to be tested at regular intervals
• Medical providers should conduct comprehensive sexual risk assessments and clinical evaluations in order to diagnose and treat syphilis correctly. The CDC recently published its 2010 treatment guidelines which include comprehensive information regarding management of all STDs, including syphilis. It is available at www.cdc.gov/std/treatment/2010.