The US Preventive Services Task Force (USPSTF) today reaffirmed its 2009 recommendation for early screening of all pregnant women for syphilis following a massive surge of cases of congenital syphilis. The statement was published September 4 in the JAMA with an accompanying editorial in JAMA Dermatology.
The newest guidance is a class ‘A’ recommendation which means that there exists substantial evidence in favor of the benefits of early screening for mother and fetus.
Vertical transmission of syphilis can occur any time and at any stage during pregnancy, and congenital syphilis is associated with adverse outcomes such as preterm birth, low birth weight, stillbirth, congenital anomalies, active syphilis in the newborn (NB) and long-term health sequelae such bone deformities and neurologic impairment.
In the US, the incidence of congenital syphilis has increased by nearly 87% between 2012 to 2016, after a steady decline during the previous 4 years. The rise coincides with rising national rates of syphilis among women of reproductive age – from 0.9 cases of primary and secondary syphilis infection per 100,000 women in 2012 to 1.9 cases in 2016.
The USPSTF recommends that all pregnant women should be screened for syphilis as early as possible when they present at the healthcare provider’s office. If a woman presents directly in labor and has not received any testing earlier, she should be immediately tested.
The screening test for syphilis is a two-step process– initially a “nontreponemal” antibody test (i.e., Venereal Disease Research Laboratory test or rapid plasma reagin [RPR] test) is done to detect biomarkers released from damage caused by syphilis infection, followed by a confirmatory “treponemal” antibody detection test (i.e., fluorescent treponemal antibody absorption or T pallidum particle agglutination test).
A newer alternative is a reverse sequence screening algorithm that involves an automated treponemal test (such as an enzyme-linked, chemiluminescence, or multiplex flow immunoassay first, followed by a nontreponemal test.
The CDC has recommended parenteral benzathine penicillin G for the treatment of syphilis in pregnant women. Evidence in favor of the safety of alternative treatment is limited; therefore, women who present with an allergy to penicillin should be evaluated and desensitized first and treated with the drug.
One way to decrease the incidence of congenital syphilis is to bring down the rates of primary and secondary syphilis infection among all women. Lower rates of syphilis in women prevent the sexual transmission and subsequent vertical transmission of congenital syphilis. Hence, the USPSTF recommends screening for syphilis in nonpregnant adolescents and adults at increased risk for infection.
The current recommendations are in accordance with those issued by other professional organizations. The CDC recommends screening for syphilis infection in all pregnant women at their first contact with the provider. The CDC, AAP, and ACOG also recommend repeat screening at 28 weeks of gestation and again at delivery in women who are at high risk for syphilis infection.
High-risk women include those with HIV or a history of incarceration or commercial sex worker. ACOG and AAP also recommend repeat screening after encountering an infected partner.
JAMA Full article
