A Statewide Recommendation for Opt-Out Syphilis Screening in Nonpregnant Adults: Rationale and Evidence-to-Decision Framework

Introduction: Syphilis rates have increased substantially across the U.S. over the past decade. In response, the Minnesota Department of Health reviewed and updated its screening recommendations. Methods: A scoping review was performed to identify published manuscripts and guidelines on syphilis screening. The Minnesota Department of Health reviewed national and local syphilis data (2016-2024), published evidence, and screening approaches from other jurisdictions. The final recommendation was based on decisional factors derived from the GRADE evidence-to-decision framework and an adaptation of evidence-to-decision that is specific to screening. Multiple factors were considered, including disease burden, treatment availability, screening accessibility, implementation feasibility, and access to health care. Results: Evidence shows that early detection and treatment of syphilis are highly effective. Opt-out screening models achieve greater uptake and case detection than risk-based screening approaches. On the basis of the findings, the Minnesota Department of Health endorsed a new universal, opt-out syphilis screening recommendation for all nonpregnant individuals aged 18-49 years. Conclusions: Universal opt-out screening for syphilis has the potential to reduce the syphilis disease burden in Minnesota. Other jurisdictions may wish to adopt similar policies and may do so by modeling this approach.