February 08, 2018, 10:31 am Chris Crawford — It's an unfortunate reality that the number of infants born with congenital syphilis in the United States nearly doubled from 2012 to 2016. Congenital syphilis can lead to intrauterine fetal demise or death within the first month after birth, premature birth, or low birth weight. Babies born with the disease also may have birth defects, such as bone deformities, blindness or deafness.
However, congenital syphilis can be prevented by screening for syphilis and treating women found to have the disease early in pregnancy.
The U.S. Preventive Services Task Force (USPSTF) examined evidence supporting this screening and, on Feb. 6, issued a draft recommendation statement and draft evidence review recommending that all pregnant women be screened for syphilis -- an "A" statement.
"The Task Force found clear evidence that screening and treating pregnant women for syphilis helps prevent the infection from being passed to the baby," said USPSTF member Melissa Simon, M.D., M.P.H., in a news release. "It's important to screen early in pregnancy, when treatment is most effective in preventing the baby from getting syphilis."
This draft recommendation statement reaffirms the USPSTF's 2009 final recommendation, which the AAFP echoed in its own recommendation at the time.
The USPSTF commissioned a targeted evidence review of literature on this topic published since 2008 and determined that the net benefit of screening for syphilis infection in pregnant women continues to be well established. Specifically, the USPSTF found convincing evidence that screening all pregnant women helps reduce the incidence of congenital syphilis and related negative birth outcomes.
"Because the early stages of syphilis often don't cause any symptoms, screening helps identify the infection in pregnant women who may not realize they have the disease," said USPSTF member Chien-Wen Tseng, M.D., M.P.H., M.S.E.E., in the release. "This is why the task force recommends that all pregnant women be screened for syphilis."
It also should be noted that most states mandate screening all pregnant women at some point during pregnancy, and many mandate screening at the time of delivery.
As for treating syphilis in pregnant women, the draft recommendation cited a 2015 CDC guideline on treatment of sexually transmitted diseases that recommended use of parenteral benzathine penicillin G.
"Evidence on the efficacy or safety of alternative antibiotic medications in pregnancy is limited; therefore, women who report a penicillin allergy should be evaluated for penicillin allergy and, if present, desensitized and treated with penicillin," the draft recommendation stated.
Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News that testing for syphilis infection in pregnancy is considered standard care.
Prenatal profiles include a syphilis screening test, usually a rapid plasma regain (RPR) test, she said.
"A negative RPR is a negative test," Frost said. "A positive RPR indicates the need for confirmatory testing, such as the fluorescent treponemal antibody test. RPR can be positive for reasons other than syphilis, so confirmatory testing is essential for making the diagnosis."
Some women may benefit from repeat testing later in pregnancy, she added, particularly those who live in communities with a high prevalence of syphilis.
According to the CDC, pregnant women at high risk for syphilis infection who warrant repeat testing also include those with a history of syphilis infection, incarceration or drug use, as well as women who have multiple or concurrent sex partners.
"Persons with a diagnosed sexually transmitted disease may be more likely than others to engage in high-risk behavior, which places them at increased risk for syphilis infection," the draft recommendation noted.
Frost added that women who do not have prenatal testing may be tested when they present to labor and delivery.
The USPSTF is inviting comments on its draft recommendation statement and draft evidence review. The public comment window is open until 8 p.m. EST on March 5. All comments received will be considered as the task force prepares its final recommendation.
The AAFP will review the USPSTF's draft recommendation statement and supporting evidence and provide comments to the task force. The Academy will release its own recommendation on the topic after the task force finalizes its guidance.