Assessment of Syphilis Screening Following Policy Implementation in an Outpatient Clinic Setting as an Outbreak Response Activity

CONTEXT: Between 2020 and 2022, the US saw sharp increases in syphilis cases, particularly among American Indian and Alaska Native (AI/AN) people. In July of 2023, the Indian Health Service (IHS), the federal agency charged with providing health care services to AI/AN people, recommended annual syphilis screening for all people aged 13 to 64 years to address the nationwide syphilis outbreak. OBJECTIVES: To assess annual syphilis screening policy recommendation changes at an outpatient clinical facility in 1 IHS clinical service unit and associated case finding outcomes between May 2022 and May 2025. DESIGN: A retrospective analysis of medical and public health records related to syphilis screening and positivity as a public health practice activity. SETTING: An outpatient clinical facility in 1 IHS clinical service unit in South Dakota. PARTICIPANTS: Any 13- to 64-year-old person who had at least 1 visit to primary care services at the facility. Individuals were eligible for inclusion once for each year analyzed. A total of 27 282 unique visits were analyzed. INTERVENTION: Implementation of an annual syphilis screening policy for those aged 13 to 64 years. MAIN OUTCOME MEASURE: Percentage change in syphilis screening coverage. RESULTS: Syphilis screening coverage increased by 57% overall after policy implementation, including increased coverage among females, males, all age groups, and pregnant people. A total of 354 cases of syphilis were newly diagnosed. CONCLUSIONS: After implementation of a facility-based annual syphilis screening policy for those aged 13 to 64 years, screening coverage for syphilis increased nearly 60% and over 350 cases of syphilis were identified during a syphilis outbreak in the community. In this outbreak setting, increased screening facilitated case finding and represents an important component of overall outbreak response efforts.