The U.S. Preventive Services Task Force (USPSTF) is urging all pregnant women to get tested for syphilis early in pregnancy, even if they have no symptoms or risk factors. This follows a sharp rise in cases of congenital syphilis—syphilis passed from mother to baby during pregnancy.
A Growing Concern: Syphilis in Newborns
In 2023, nearly 3,900 babies were born with congenital syphilis in the U.S., the highest number in three decades. Many of these cases could have been avoided if the mothers had received timely testing and treatment.
Sadly, 279 of these babies died before, during, or shortly after birth. Congenital syphilis can also cause serious health issues like early birth, low birth weight, bone problems, hearing loss, and even meningitis.
Racial and Ethnic Disparities in Syphilis Rates
Rates of congenital syphilis are not equal among racial and ethnic groups. Native American and Alaska Native women had the highest rate at 680 cases per 100,000 live births. Other high rates were reported among Native Hawaiian/Pacific Islander, Black, and Hispanic/Latina women.
In contrast, White women had a lower rate at 57.3 cases per 100,000. Experts believe that differences in income, access to healthcare, and community resources play a role in these disparities.
What the USPSTF Recommends
The USPSTF continues to support its 2018 recommendation: test every pregnant woman for syphilis early in pregnancy. Testing and treating syphilis as early as possible can prevent problems for both the mother and baby. But even late treatment can help protect the baby from infection.
How Doctors Test for Syphilis
There are a few types of tests doctors use to check for syphilis:
Treponemal tests, like the TP-PA test, detect antibodies specific to the syphilis-causing bacteria.
Non-treponemal tests, such as VDRL and RPR, detect general infection-related antibodies and must be followed by a more specific test to confirm syphilis.
Automated lab tests, like enzyme-linked immunoassays, may be used first. If results are unclear, further testing is needed.
Point-of-care (POC) tests are available for quick screening but still need more validation before being fully trusted.
Treating Syphilis During Pregnancy
The CDC recommends a penicillin G injection as the best treatment for syphilis during pregnancy. If the woman is allergic to penicillin, doctors can help desensitize her so the drug can still be used safely.
Treatment may cause temporary side effects, like fever, rash, or low blood pressure. These are rare but manageable. In high-risk allergy patients, oral desensitization has higher reaction rates than IV methods.
If syphilis is found in the second half of pregnancy, doctors will also check the baby’s health using an ultrasound.
Should Pregnant Women Be Tested More Than Once?
One test early in pregnancy may not be enough. In some cases, babies are still born with syphilis even after their mothers tested negative early on.
To prevent this, groups like the CDC, Women’s Preventive Services Initiative, and the American Academy of Pediatrics advise rescreening high-risk women around 28 weeks and again at delivery. High-risk groups include women who:
- Live in areas with high syphilis rates
- Have HIV
- Are in prison
- Have multiple sexual partners
The American College of Obstetricians and Gynecologists (ACOG) goes further and recommends rescreening all pregnant women.
However, the USPSTF says there isn’t enough clear evidence to recommend rescreening for everyone and calls for more research.
What This Means for Pregnant Women and Doctors
Doctors should be familiar with local syphilis rates and follow state laws, which may require universal testing or rescreening. Pregnant women should talk to their healthcare provider about getting tested, especially early in pregnancy.
Conclusion
Early testing for syphilis saves lives. With congenital syphilis cases rising, health experts are stressing the importance of screening every pregnant woman. Testing is quick, and treatment is safe and effective. In many cases, it can mean the difference between a healthy baby and a serious infection.
Read more:
