Editing Syphilis (section)

==Prevention==

===Vaccine===
{{As of|2018}}, there is no [[vaccine]] effective for prevention.<ref name=ST10/> Several vaccines based on treponemal proteins reduce lesion development in an [[animal model]] but research continues.<ref>{{cite journal |last1=Cameron |first1=Caroline E. |last2=Lukehart |first2=Sheila A. |title=Current status of syphilis vaccine development: Need, challenges, prospects |journal=Vaccine |date=March 2014 |volume=32 |issue=14 |pages=1602–1609 |doi=10.1016/j.vaccine.2013.09.053 |pmid=24135571 |pmc=3951677 }}</ref><ref>{{cite journal |last1=Cameron |first1=Caroline E. |title=Syphilis Vaccine Development |journal=Sexually Transmitted Diseases |date=September 2018 |volume=45 |issue=9S Suppl 1 |pages=S17–S19 |doi=10.1097/OLQ.0000000000000831 |pmid=29528992 |pmc=6089657 }}</ref>

===Sex===
[[Condom]] use reduces the likelihood of transmission during sex, but does not eliminate the risk.<ref>{{cite journal |date=July 2009|title=A systematic review of epidemiologic studies assessing condom use and risk of syphilis|journal=Sex Transm Dis|volume=36|issue=7|pages=401–5|doi=10.1097/OLQ.0b013e3181a396eb|pmid=19455075|vauthors=Koss CA, Dunne EF, Warner L|s2cid=25571961}}</ref> The [[Centers for Disease Control and Prevention]] (CDC) states, "Correct and consistent use of latex condoms can reduce the risk of syphilis only when the infected area or site of potential exposure is protected.<ref>{{cite web |title=Condom Fact Sheet in Brief {{!}} CDC |url=https://www.cdc.gov/condomeffectiveness/brief.html |website=www.cdc.gov |access-date=29 July 2019 |date=18 April 2019 |archive-date=26 July 2019 |archive-url=https://web.archive.org/web/20190726042736/https://www.cdc.gov/condomeffectiveness/brief.html |url-status=live }}</ref> However, a syphilis sore outside of the area covered by a latex condom can still allow transmission, so caution should be exercised even when using a condom."<ref name="CDC Fact Sheet"/>

[[Abstinence]] from intimate physical contact with an infected person is effective at reducing the transmission of syphilis. The CDC states, "The surest way to avoid transmission of sexually transmitted diseases, including syphilis, is to abstain from sexual contact or to be in a long-term mutually [[monogamous]] relationship with a partner who has been tested and is known to be uninfected."<ref name="CDC Fact Sheet">{{cite web |title= Syphilis - CDC Fact Sheet |publisher= [[Centers for Disease Control and Prevention]] (CDC) |date= 16 September 2010 |url= https://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm |access-date= 30 May 2007 |url-status= live |archive-url= https://web.archive.org/web/20120916073018/http://www.cdc.gov/std/syphilis/STDFact-Syphilis-detailed.htm |archive-date= 16 September 2012}}</ref>

===Congenital disease===
[[File:Portrait of Mr. J. Kay, afflicted with a rodent disease. Unknown artist, c. 1820 CE. The Wellcome Collection, London.jpg|thumb|Portrait of a man affected with what is now believed to have been congenital syphilis, {{circa|1820}}<ref>{{cite web|title=A young man, J. Kay, afflicted with a rodent disease which has eaten away part of his face. Oil painting, ca. 1820.|url=https://wellcomelibrary.org/item/b16031179#?c=0&m=0&s=0&cv=0|website=wellcomelibrary.org|access-date=28 July 2017|url-status=live|archive-url=https://web.archive.org/web/20170728084800/https://wellcomelibrary.org/item/b16031179#?c=0&m=0&s=0&cv=0|archive-date=28 July 2017}}</ref>]]
Congenital syphilis in the newborn can be prevented by screening mothers during early pregnancy and treating those who are infected.<ref name=Screening04>{{cite journal |last=Schmid|first=G|title=Economic and programmatic aspects of congenital syphilis prevention|journal=Bulletin of the World Health Organization|date=June 2004|volume=82|issue=6|pages=402–9|pmid=15356931|pmc=2622861}}</ref> The [[United States Preventive Services Task Force]] (USPSTF) strongly recommends universal screening of all pregnant women,<ref>{{cite journal |last=U.S. Preventive Services Task|first=Force|title=Screening for syphilis infection in pregnancy: U.S. Preventive Services Task Force reaffirmation recommendation statement|journal=Annals of Internal Medicine|date=19 May 2009 |volume=150|issue=10|pages=705–9|pmid=19451577|doi=10.7326/0003-4819-150-10-200905190-00008|doi-access=free}}</ref> while the [[World Health Organization]] (WHO) recommends all women be tested at their first antenatal visit and again in the [[third trimester]].<ref name=Lancet11/><ref>{{cite web |title=Prenatal Syphilis Screening Laws |url=https://www.cdc.gov/std/treatment/syphilis-screenings-2018.htm |website=www.cdc.gov |access-date=29 July 2019 |date=8 April 2019 |archive-date=28 July 2019 |archive-url=https://web.archive.org/web/20190728221453/https://www.cdc.gov/std/treatment/syphilis-screenings-2018.htm |url-status=live }}</ref> If they are positive, it is recommended their partners also be treated.<ref name=Lancet11/> Congenital syphilis is still common in the developing world, as many women do not receive [[antenatal care]] at all, and the antenatal care others receive does not include screening.<ref name=Screening04/><ref>{{cite journal |last1=Phiske |first1=MM |title=Current trends in congenital syphilis. |journal=Indian Journal of Sexually Transmitted Diseases and AIDS |date=January 2014 |volume=35 |issue=1 |pages=12–20 |doi=10.4103/0253-7184.132404 |pmid=24958980|pmc=4066591 |doi-access=free }}</ref> It still occasionally occurs in the developed world, as those most likely to acquire syphilis are least likely to receive care during pregnancy.<ref name=Screening04/> Several measures to increase access to testing appear effective at reducing rates of congenital syphilis in low- to middle-income countries.<ref name=Lancet11>{{cite journal |last=Hawkes|first=S|author2=Matin, N |author3=Broutet, N |author4=Low, N |title=Effectiveness of interventions to improve screening for syphilis in pregnancy: a systematic review and meta-analysis|journal=The Lancet Infectious Diseases|date=15 June 2011 |pmid=21683653|volume=11|issue=9|pages=684–91|doi=10.1016/S1473-3099(11)70104-9}}</ref> [[Point-of-care testing]] to detect syphilis appeared to be reliable, although more research is needed to assess its effectiveness and into improving outcomes in mothers and babies.<ref>{{cite journal |last1=Shahrook|first1=S|last2=Mori|first2=R|last3=Ochirbat|first3=T|last4=Gomi|first4=H|title=Strategies of testing for syphilis during pregnancy.|journal=The Cochrane Database of Systematic Reviews|date=29 October 2014|volume=2014|issue=10|pages=CD010385|pmid=25352226|doi=10.1002/14651858.CD010385.pub2|pmc=11126892}}</ref>

===Screening===
The CDC recommends that sexually active men who have sex with men be tested at least yearly.<ref>{{cite web|title=Trends in Sexually Transmitted Diseases in the United States: 2009 National Data for Gonorrhea, Chlamydia and Syphilis|url=https://www.cdc.gov/std/stats09/tables/trends-table.htm|publisher=[[Centers for Disease Control and Prevention]]|date=22 November 2010|access-date=3 August 2011|url-status=live|archive-url=https://web.archive.org/web/20110804025120/http://www.cdc.gov/std/stats09/tables/trends-table.htm|archive-date=4 August 2011}}</ref> The USPSTF also recommends screening among those at high risk.<ref>{{cite journal |last1=Bibbins-Domingo|first1=Kirsten|last2=Grossman|first2=David C.|last3=Curry|first3=Susan J.|last4=Davidson|first4=Karina W.|last5=Epling|first5=John W.|last6=García|first6=Francisco A. R.|last7=Gillman|first7=Matthew W.|last8=Harper|first8=Diane M.|last9=Kemper|first9=Alex R.|last10=Krist|first10=Alex H.|last11=Kurth|first11=Ann E.|last12=Landefeld|first12=C. Seth|last13=Mangione|first13=Carol M.|last14=Phillips|first14=William R.|last15=Phipps|first15=Maureen G.|last16=Pignone|first16=Michael P.|title=Screening for Syphilis Infection in Nonpregnant Adults and Adolescents|journal=JAMA|date=7 June 2016|volume=315|issue=21|pages=2321–7|doi=10.1001/jama.2016.5824|pmid=27272583|author1-link=Kirsten Bibbins-Domingo|doi-access=free}}</ref>

Syphilis is a [[notifiable disease]] in many countries, including Canada,<ref>{{cite web|title=National Notifiable Diseases|url=http://dsol-smed.phac-aspc.gc.ca/dsol-smed/ndis/list-eng.php|publisher=Public Health Agency of Canada|date=5 April 2005|access-date=2 August 2011|url-status=live|archive-url=https://web.archive.org/web/20110809162040/http://dsol-smed.phac-aspc.gc.ca/dsol-smed/ndis/list-eng.php|archive-date=9 August 2011}}</ref> the [[European Union]],<ref>{{cite journal |last=Viñals-Iglesias|first=H|author2=Chimenos-Küstner, E|title=The reappearance of a forgotten disease in the oral cavity: syphilis|journal=Medicina Oral, Patologia Oral y Cirugia Bucal|date=1 September 2009 |volume=14|issue=9|pages=e416–20|pmid=19415060}}</ref> and the United States.<ref>{{cite web|title=Table 6.5. Infectious Diseases Designated as Notifiable at the National Level-United States, 2009 [a]|url=http://www.unboundmedicine.com/redbook/ub/view/RedBook/187389/all/Table_6_5__Infectious_Diseases_Designated_as_Notifiable_at_the_National_Level_United_States__2009_%5Ba%5D|work=Red Book|access-date=2 August 2011|url-status=dead|archive-url=https://archive.today/20120913180413/http://www.unboundmedicine.com/redbook/ub/view/RedBook/187389/all/Table_6_5__Infectious_Diseases_Designated_as_Notifiable_at_the_National_Level_United_States__2009_%5Ba%5D|archive-date=13 September 2012}}</ref> This means health care providers are required to notify [[public health]] authorities, which will then ideally provide [[partner notification]] to the person's partners.<ref>{{cite book|title=Brunner & Suddarth's textbook of medical-surgical nursing.|year=2010|publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-7817-8589-1|pages=2144|edition=12th|url=https://books.google.com/books?id=SmtjSD1x688C&pg=PA2144|url-status=live|archive-url=https://web.archive.org/web/20160518012909/https://books.google.com/books?id=SmtjSD1x688C&pg=PA2144|archive-date=18 May 2016}}</ref> Physicians may also encourage patients to send their partners to seek care.<ref>{{cite journal |last=Hogben|first=M|title=Partner notification for sexually transmitted diseases|journal=Clinical Infectious Diseases|date=1 April 2007|volume=44|issue=Suppl 3|pages=S160–74|pmid=17342669|doi=10.1086/511429|doi-access=free}}</ref> Several strategies have been found to improve follow-up for STI testing, including email and text messaging of reminders for appointments.<ref name="DesaiWoodhall2015">{{cite journal|last1=Desai|first1=Monica|last2=Woodhall|first2=Sarah C|last3=Nardone|first3=Anthony|last4=Burns|first4=Fiona|last5=Mercey|first5=Danielle|last6=Gilson|first6=Richard|title=Active recall to increase HIV and STI testing: a systematic review|journal=Sexually Transmitted Infections|volume=91|issue=5|year=2015|pages=sextrans–2014–051930|issn=1368-4973|doi=10.1136/sextrans-2014-051930|pmid=25759476|s2cid=663971|url=http://sti.bmj.com/content/sextrans/91/5/314.full.pdf|doi-access=free|access-date=18 September 2019|archive-date=23 September 2020|archive-url=https://web.archive.org/web/20200923030724/https://sti.bmj.com/content/sextrans/91/5/314.full.pdf|url-status=live}}</ref>