USPSTF finalizes recommendation on syphilis screening for all pregnant women

Key takeaways:

• Evidence remains consistent with past research supporting syphilis screening in pregnant people, the USPSTF said.
• Several barriers still impede the effectiveness of these recommendations, experts argued.

Physicians should screen for syphilis in people who are pregnant as early as possible, according to a final recommendation statement from the U.S. Preventive Services Task Force.

The A-grade recommendation is consistent with the task force’s draft recommendation and 2018 recommendation on the topic.

Joseph Cherabie, MD, MSc, medical director of the Washington University in St. Louis Capacity Building Assistance Program and a member of the HIV Medication Association board of directors, told Healio that primary care providers should have this recommendation “on their radar.”

“We were near eradicating syphilis in this country in the early 2000s, and now with increasing rates, many providers, who haven’t seen a lot of syphilis in training, are all of the sudden seeing more syphilis show up in their clinics,” Cherabie said.

Healio previously reported on CDC data which showed that more than 3,700 babies were born with congenital syphilis in 2022 — a 10-fold increase from 2012 — while the rates of congenital syphilis per 100,000 live births rose from 50.1 in 2019 to 105.9 in 2023.

Untreated syphilis can result in significant health complications, such as damage to the brain, heart and other organs, neurological issues and a higher risk for HIV, according to the Mayo Clinic.

“Syphilis needs to be on the differential to diagnose it, so this recommendation emphasizes the need for syphilis screening at least once during pregnancy,” Cherabie said.

CDC guidelines on this topic go a step further “to say that screening needs to occur in the first trimester for all individuals, and again at 28 weeks and at delivery in areas of high syphilis incidence, defined as 4.6 cases per 100,000 individuals, or if new sex partners or partners recently diagnosed with STIs,” Cherabie added.

In the final evidence report, Gary N. Asher, MD, MPH, a professor of family medicine at the University of North Carolina School of Medicine, and colleagues assessed studies published since 2017 on the benefits and harms of screening for syphilis in people who are pregnant.

They found no new studies examining the effectiveness of syphilis screening and several new studies on the harms of screening and treatment.

Overall, the evidence was consistent with prior reviews that support “the need for two-step serologic screening to reduce inaccurate screening results,” the researchers wrote.

The USPSTF said that certain diverse groups, including Asian, Black, Hispanic, Native American and Alaskan Native populations, are disproportionately affected by syphilis, likely due to social and structural factors like poverty and segregation.

The task force added that studies assessing disparities in syphilis incidence and screening rates across populations, as well as interventions aimed at reducing greater syphilis burden in some populations, are needed.

In a related editorial, Thomas E. Dobbs, MD, MPH, dean of the University of Mississippi Medical Center School of Population Health, and colleagues called the recommendation a “timely reminder of the nationwide spike in congenital syphilis.”

“As this new crisis worsens, a recommendation for repeat screening during the last trimester and testing during delivery is warmly welcomed and urgently needed,” they wrote.

However, multiple issues impede these guidelines’ effectiveness, such as limited access to timely treatment, delayed prenatal care and implicit bias among clinicians that “leads to lower levels of screening among those deemed to be at lower risk based on an assessment of superficial and difficult-to-assess factors,” Dobbs and colleagues wrote.

They concluded that clinicians need to understand their important role in preventing communicable diseases through detection, reporting and treatment, and “must maintain high fidelity to screening guidelines and take responsibility for overcoming the systematic barriers that impede effective syphilis management.”

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Joseph Cherabie, MD, MSc, can be reached at primarycare@healio.com.