By Meaghan Lee Callaghan
The U.S. Preventive Services Task Force (USPSTF) is continuing to recommend early, universal syphilis screening during pregnancy.
The new guidance, a restatement of its 2018 guideline, comes at a time when syphilis cases remain high in the United States. That also includes congenital syphilis, which caused 279 stillbirths or neonatal/infant deaths in 2023—the highest number in 30 years.
“The USPSTF found no new substantial evidence that could change its recommendation and, therefore, reaffirms its recommendation to screen for syphilis infection during pregnancy,” the authors wrote.
Giving the recommendation a letter A rating, the USPSTF has found that early, universal syphilis screening has “substantial net benefit” for pregnant patients. The USPSTF recommends that screening comes early in pregnancy, but if that is not possible, then screening should be performed at the earliest available opportunity. In addition, the screening is recommended universally, including all asymptomatic pregnant people.
Congenital Syphilis Remains High
The need to test all pregnant people is there; cases of syphilis in the United States have risen steadily over the last 30 years, according to the USPSTF. In particular, cases in women have jumped. Where syphilis used to be a disease more commonly seen in men, it’s now two to four times more common in women as of data in 2017 and 2021, according to CDC statistics. Due to this increase in women, congenital syphilis has increased 10-fold from 334 cases in 2012 to 3,882 cases in 2023 (MMWR Morb Mortal Wkly Rep 2023;72[46]:1269-1274).
How to Screen
To screen for syphilis in pregnant people, the USPSTF recommends the traditional two-step screening algorithm, starting with a nontreponemal test, such as a rapid plasma reagin test. If results come back positive, then the task force recommends following with a treponemal test, like an enzyme-linked or chemiluminescence immunoassay, for confirmation. (The USPSTF notes that nontreponemal tests alone can cause false positives, especially in pregnancy, making the second step important.) Also, a reverse sequence can be used (with a treponemal test first followed by a nontreponemal test); however, if the clinician ends up with discordant results, a second treponemal test should be run, the task force said. For this second test, Treponema pallidum particle agglutination is preferred. Although point-of-care tests are available, there are not enough data to determine what role they play in treatment decisions for pregnant patients.
For more on the USPSTF recommendations on syphilis screening in pregnant people, check out our upcoming May/June issue.
