Premarital syphilis screening: Weighing the benefits

Abstract

The overall value of the routine use of serologic tests in the control of syphilis and reduction of complications has been clearly documented during the past four decades. This value in outpatient settings has recently been underscored by Chapel in an analysis of patients with secondary syphilis who were seen by physicians in community practice. His analysis found that one-third of these patients were diagnosed only on the basis of a routine serologic test. The specific contribution of premarital testing to the overall value of routine serologic testing is less certain and must be decided in each state. Decisions regarding premarital serologic tests must be made by responsible officials in light of epidemiologic factors in the community being served. Felman portrays the dilemma which state health officials must face in deciding the appropriatenes of mandated premarital syphilis serologic testing. Our hope is that the full range of benefits which may be derived from premarital examinations will be rigorously investigated by policymakers within each affected jurisdiction. We do not oppose a state's decision to repeal its premarital laws. We do oppose an over-simplified cost-effectiveness analysis leading to that decision.