Testing everyone unless they decline found syphilis in one incarcerated Alaskan in twenty

Syphilis cases have increased substantially in the United States since 2017,
including in Alaska. **Syphilis prevalence has historically been high among
incarcerated populations**, and correctional facilities are one of the few
places where a population that rarely reaches routine healthcare can be
reached at all.

Between October 2023 and September 2025, Alaska correctional facilities
ran opt-out screening — routine testing unless a person declines.

What it found

A reactive RPR often indicates a past or current infection, so the 4.6% is not
all current disease — the 2.2% newly identified is the figure to hold. Even
so: one in forty-five people screened had syphilis nobody knew about, and
among women the reactive rate was nearly three times the men's.

Why opt-out matters

The design is the finding. **Opt-out screening tests everyone unless they
decline**, rather than testing people who ask or who a clinician judges to be
at risk. Risk-based testing in a population where the risk is general finds a
fraction of what is there, and it depends on a conversation that often does
not happen.

What it prevents

The report's implications run outward from the facility:

• **Increase syphilis detection and treatment among people who are
  incarcerated or detained**
• Reduce community syphilis transmission — people leave, and the infection
  goes with them
• Help prevent congenital syphilis — which is the sharpest of the three,
  because congenital syphilis is entirely preventable by treating the mother,
  and the 9.3% reactive rate among women screened is where that begins

*Source: Ohlsen E, Rogers J, Clark S, Lawrence R, McLaughlin J. Syphilis
Screening in Correctional Facilities — Alaska, October 2023–September 2025.
MMWR, Centers for Disease Control and Prevention.*