Data of 1,290,222 volunteer blood donors, in a 5-year period, was analyzed for prevalence and incidence of syphilis. Subsequent testing of donations positive in Treponema pallidum hemagglutination assay included Venereal Disease Research Laboratory and fluorescent Treponemal antibody absorption. Stepwise logistic regression model was used to identify positive syphilis serology. Prevalence of syphilis was 47？:？100,000, similar in men and women and increased significantly with age ( ). Native Israelis had the lowest prevalence rate of syphilis (21？:？100,000), while a significantly higher prevalence was found among immigrants from Africa, Eastern Europe, and South America (odds ratios of 19.0, 10.8, and 7.3, resp., for each). About 33.2% of the seropositive donors had evidence of recent infection, and 66.8% had past infections. Incidence rate reached 8？:？100,000 person-years. Coinfection with HIV, HCV, and HBV was calculated as 8%, 1.88%, and 0.37% for positive donations, respectively. The data support the need to continue screening blood donors in Israel for syphilis and employ preventive measures to populations at risk, in order to improve public health, blood safety, and quality. A subsequent study to assess blood donors’ knowledge, attitude, and behavior is planned. In times of global migration this information may be useful to blood services worldwide. 1. Introduction Syphilis is a sexually transmitted disease (STD) caused by Treponema pallidum, which can also be transmitted via accidental direct inoculation, transplacenta during pregnancy, and, rarely, via blood transfusion [1, 2]. Although the value of routine serologic screening of blood donors for syphilis has been a question in debate for years [3–5], and refrigerated blood components are less infective for syphilis, transmissions through blood components still occur [6]. Therefore, standard operating procedures of blood establishments worldwide include demands/recommendations for such screening [7, 8]. New draft guidance for screening, testing, and management of blood donors and components was recently distributed by the FDA [9]. In many parts of the world, the incidence and prevalence of syphilis still remain high in both volunteer and family/replacement blood donors [10–15]. There are numerous reports in high-risk groups in the literature, both from developed and developing countries, indicating rising prevalence and incidence of syphilis [16–20]. In Israel, screening tests for syphilis are conducted in community STD clinics for the general and high-risk populations, by the National Blood
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