As the incidence of congenital syphilis increases rapidly, the American College of Obstetricians and Gynecologists (ACOG) recently issued new guidelines suggesting more frequent testing during pregnancy. ACOG now recommends that all pregnant women be screened three times: at their first prenatal visit, in the third trimester, and at birth.
This differs slightly from the Centers for Disease Control and Prevention's (CDC) treatment guidelines and the organization's initial recommendations, which take a risk-based approach to third trimester screenings.
What is syphilis and why should pregnant women get tested?
Syphilis is an infection caused by bacteria. Treponema Pallor. It can be spread during vaginal, anal, or oral sex. Congenital syphilis is spread from a pregnant person to her baby during pregnancy or childbirth.
In recent years, syphilis cases have been on the rise, and cases of syphilis are also rapidly increasing among newborns. In 2022 alone, there were 3,755 babies born with congenital syphilis. This is more than 10 times more babies born with syphilis in 2012.
Syphilis during pregnancy is a serious problem. It can lead to miscarriage, stillbirth, and even infant death. Babies born with syphilis may face medical problems throughout their lives.
Public health experts agree that the rise in congenital syphilis means a failure to prevent STIs and prenatal care not available to all pregnant women. The CDC notes that 40% of babies born with syphilis in 2022 did not receive adequate prenatal care.
Some pregnant patients were not tested for syphilis, and others were not treated even after testing positive. CDC believes that 9 out of 10 cases of congenital syphilis could be prevented through timely testing and treatment.
Recommendations for syphilis testing during pregnancy
Screening guidelines have always suggested that all pregnant women be tested for syphilis at their first prenatal visit. In fact, most states have laws mandating syphilis testing at the first visit. However, only 15 states require repeat syphilis testing in the third trimester of pregnancy, and only 6 states require testing at birth.
A handful of states say people at high risk should get a second, and possibly third, test, following guidance from the CDC and ACOG so far.
CDC treatment guidelines (2021) suggest that screening should be performed in the third trimester of pregnancy and at birth for pregnant women who are at high risk due to their living situation (such as those who are homeless, incarcerated, or living in communities with high rates of syphilis). Behaviors (such as using drugs, having sex, or having multiple partners while pregnant).
ACOG continues to support CDC treatment guidelines but is now recommending that its members move away from the risk model. ACOG's updated recommendations account for these changes.“[I]Given the rapidly increasing rates of congenital syphilis, obstetricians and other obstetricians should screen all pregnant women serologically for syphilis at their first prenatal care visit, followed by universal retesting in the third trimester of pregnancy and at birth. It’s a risk-based approach to testing.”
The organization also emphasizes that most cases of congenital syphilis can be prevented through appropriate prenatal care. For this reason, we tell our members, “It is important to create opportunities for syphilis testing whenever they seek medical care during pregnancy, including in emergency rooms, prisons, syringe service programs, and maternal and child health programs.”
Congenital syphilis can be prevented through extensive testing and treatment. Hopefully, these new guidelines will help increase screening for pregnant women.