Every pregnant woman should undergo screening for sexually transmitted diseases (STDs), particularly for syphilis, due to alarming increases in rates of stillbirths and congenital defects in babies. This crucial recommendation comes from the U.S. Preventive Services Task Force (USPSTF), a prominent medical panel that establishes clinical care guidelines across the nation. In their latest guidance issued today, the Task Force emphasizes that doctors should routinely screen for syphilis throughout pregnancy.
Syphilis is a bacterial infection that can be transmitted from a mother to her baby in utero, leading to a condition known as congenital syphilis. This infection can significantly hinder fetal development, resulting in serious health complications. The incidence of syphilis has surged dramatically in recent years, primarily due to a combination of factors including insufficient testing, treatment gaps, prenatal care deficiencies, substance abuse, social stigma, and delays in testing.
In 2023, the United States reported nearly 4,000 cases of congenital syphilis, marking an increase of more than a third compared to 2021 and an astonishing tenfold rise from a decade ago. Additionally, there were 279 stillbirths linked to congenital syphilis, the highest number recorded in 30 years. Although a federal recommendation in 2018 advised screening for all pregnant women, the USPSTF is reiterating its importance in light of these rising statistics.
According to the updated guidelines, women should be screened for syphilis during their initial visit with a gynecologist, ideally between eight and twelve weeks of pregnancy. The USPSTF also recommends additional screening at 28 weeks’ gestation and again at the time of delivery. Task Force members stated, “We conclude with high certainty that screening for syphilis infection in pregnancy has a substantial net benefit.”
Congenital syphilis can lead to severe, long-term complications for infants. Babies may be born too early, too small, or stillborn. Newborns infected with syphilis can face life-threatening issues such as severe anemia, swollen liver and spleen, jaundice (yellowing of the skin), and bone deformities. Additionally, the infection can inflict brain and nerve damage, resulting in inflammation, blindness, and permanent hearing loss.
A recent analysis of national data from 2022 revealed that 5% of congenital syphilis cases occurred late in pregnancy after women had previously tested negative. Disparities in these cases are evident, with 40.6% occurring in Black women, 28.4% in Hispanic or Latina women, and 19.8% in White women. Some studies suggest that 25% to 50% of congenital syphilis cases could be prevented through repeat screening in the third trimester.
The USPSTF highlights that congenital syphilis cases have increased more than tenfold over the past decade, from 334 cases in 2012 to 3,882 cases in 2023. It is estimated that nearly 90% of new congenital syphilis cases could have been averted with timely testing and treatment. Fortunately, the infection can be effectively treated in utero with penicillin, particularly if administered before the second trimester.
Screening for congenital syphilis involves a blood test that detects antibodies indicative of an infection with Treponema pallidum, the bacterium responsible for syphilis. Most states mandate screening for syphilis during the first prenatal visit and require repeat screenings during the third trimester and at delivery. However, it is important to note that pregnancy can sometimes lead to false positive results due to hormonal changes or autoimmune conditions. A positive result must be confirmed with a more specific test.
The spread of syphilis is often exacerbated by social factors such as homelessness, which can limit access to handwashing facilities and public restrooms. The infection is also more prevalent among women living in areas with high incidence rates, as well as those with a history of HIV, incarceration, or involvement in sex work. The USPSTF urges clinicians to be aware of the prevalence of syphilis in their communities and the importance of adhering to state mandates for screening.
