USPSTF reiterates screening for syphilis in pregnant women

November 15, 2018

In an update to the 2009 recommendations, the USPSTF notes why early STD screening in pregnant patients is so important for both mother and baby.

The United States Preventive Services Task Force (USPSTF) has reaffirmed its recommendation that all pregnant women be screened for the sexually transmitted disease (STD).

In its update to the 2009 recommendation, which appears in JAMA, USPSTF noted that following a steady decline in congenital syphilis from 2008 to 2012, there was a marked increase from 2012 to 2016, specifically from 8.4 to 15.7 cases per 100,00 live births, for an overall increase of 87%.

During the same period, national rates of syphilis also rose among women of reproductive age.

“More and more babies are being born infected with syphilis, which can cause devastating health consequences, such as low birthweight, birth defects, and even death,” said Chien-Wen Tseng, MD, MPH, MSEE, a member of the task force and Hawaii Medical Service Association endowed chair in health services and quality research at the University of Hawaii John A. Burns School of Medicine in Honolulu. “Through early screening and treatment of syphilis in pregnant women, we prevent its transmission to babies in utero or at birth. Because of this, it was crucial for the task force to re-emphasize the importance of early screening for syphilis in all pregnant women.”

Dr. Tseng told Contemporary OB/GYNthat the task force continues to recommend that all pregnant women be screened for syphilis as early as possible in their pregnancy because signs or symptoms of the STD may not always be present. “In 7 of 10 cases of congenital syphilis, women received prenatal care – just not early enough in the pregnancy to prevent the transmission to the baby,” she said. “Syphilis screening is a simple blood test that is part of standard prenatal labs.”

A 2013 systematic review of six case-control studies concluded that maternal syphilis infection during pregnancy was linked to an absolute difference of 21% for stillbirth or fetal loss, 9% for neonatal death and 5% for prematurity or low birthweight, compared with pregnancies unaffected by the STD.

Through a reaffirmation process, the task force found that accurate screening algorithms are available to identify syphilis infection. Conversely, the task force did not uncover any new evidence that countered the benefits of screening for it in pregnant women. 

In addition, the task force discovered no new studies that assessed the effectiveness of repeated testing for syphilis during pregnancy, despite being recommended for women at high risk for the STD early in the third trimester by the Centers for Disease Control and Prevention and joint guidelines from the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists. 

Syphilis during pregnancy is treated with penicillin, “which is highly effective in treating both the pregnant woman and her baby,” Dr. Tseng said. “There is also convincing evidence that early screening and treatment for syphilis in pregnant women can prevent syphilis transmission and its health consequences, including loss of the pregnancy and death of the baby.”

However, while screening rates for syphilis infection are mostly high among pregnant women, the only time 20% of these women are screened are at delivery.

Clinicians should also be aware of the prevalence of syphilis infection in their community because rates can vary by geography.   

“Now more than ever, we must work to help pregnant women get screened and treated for syphilis as early as possible in their pregnancy,” Dr. Tseng said. “By doing so, clinicians can help all pregnant women and their babies live longer and healthier lives.” 

Disclosures:

Dr. Tseng reports no relevant financial disclosures.