Breaking Reminder: Syphilis Screening Urged for All Pregnant Women

The number of congenital syphilis cases is rising at an alarming rate.  From 2012-2016 the rate of congenital syphilis increased by 87% (from 8.4 to 15.7 cases per 100,000 live births).¹   According to historical data, up to 40% of pregnancies with untreated syphilis will result in miscarriage, stillbirth, or infant death.  And those infants who live are at risk for skeletal abnormalities; hepatosplenomegaly; jaundice; anemia; and other complications which can cause developmental delays and seizures.²   Given that congenital syphilis is preventable and the established benefits of screening for syphilis in pregnant women, the U.S. Preventive Services Task Force (USPSTF) has reaffirmed its 2009 recommendation to screen all pregnant women for syphilis as early as possible in pregnancy.⁴

In 2015, Texas legislature passed a law (Senate Bill 1128) requiring every pregnant woman be tested for syphilis at the first prenatal visit AND again during their third trimester.³  Dr. Susan J. Curry and her coauthors affirmed that “although nearly 70% of infants with congenital syphilis are born to mothers who received prenatal care, detection and treatment of maternal syphilis often occurs too late to treat the fetus and prevent congenital syphilis.”¹  USPSTF also recommends that pregnant women who have not received prenatal care be screened for syphilis at delivery.  “Recent data suggest that while screening rates for syphilis infection are generally high, the proportion of women screened earlier in pregnancy remains low (for example, 20% of women are screened only at the time of delivery).”¹

TCHP reminds all obstetric care providers to screen for syphilis at the first prenatal visit AND again in the third trimester.  Effective treatment with antibiotics can prevent congenital syphilis and significantly decrease adverse pregnancy outcomes.  The CDC currently recommends IM injection with benzathine penicillin G as the treatment of choice for syphilis in pregnant women. ²    However, USPSTF recommends clinicians consult the CDC website for updates.⁴

The increase in congenital syphilis and the devastating effects of the disease necessitates consistent action in order to eliminate its prevalence in Texas.   For more info:  https://www.dshs.texas.gov/hivstd/info/syphilis/

1. Bibbins-Domingo  K, Grossman  DC, Curry  SJ,  et al; US Preventive Services Task Force (USPSTF).  Screening for syphilis infection in nonpregnant adults and adolescents: US Preventive Services Task Force recommendation statement. JAMA. 2016;315(21):2321-2327. doi:10.1001/jama.2016.5824

2. Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases (STDs). CDC website. https://www.cdc.gov/std/syphilis/stdfact-congenital-syphilis.htm . Accessed September 2018.

3. Texas Health and Human Services. Congenital Syphilis Legislative Report. Texas Department of State Health Services website. https://www.dshs.texas.gov/hivstd/reports/ .  Accessed September 2018.

4. US Preventive Services Task Force (USPSTF). Procedure Manual. USPSTF website. https://www.uspreventiveservicestaskforce.org/Page/Name/procedure-manual. 2018. Accessed July 17, 2018.