Clinical Practice: Syphilis Resurgence Reminds Us of the Importance of STD Screening and Treatment during Prenatal Care

Just over a decade ago, we were approaching the elimination of syphilis. An infection causing widespread devastation for much of the past century was nearly wiped out. However, syphilis has not gone away quietly. Today, we find ourselves facing another uphill climb. An increase in syphilis among women has led to the highest number of congenital syphilis cases since 2001. In 2015, 487 congenital syphilis cases were reported nationwide, and indicators show that this number grew in 2016.

Syphilis infection during pregnancy can result in significant health problems for an infant. Historical data indicate that up to 40% of pregnancies in women with untreated syphilis will result in miscarriage, stillbirth, or infant death. Infants who live may develop severe illness including skeletal abnormalities; hepatosplenomegaly; jaundice; anemia; optic atrophy; interstitial keratitis; sensorineural deafness; or meningitis, which can cause developmental delays and seizures. And yet, congenital syphilis is preventable.

The playbook for stopping syphilis was written decades ago. Unfortunately, many physicians today don’t have syphilis on their radar because they haven’t seen or heard about any cases from their colleagues. This lack of awareness, combined with syphilis’ ability to camouflage itself as different infections, requires that we get back to the fundamentals of syphilis prevention. There are actions you can take to help reverse this growing trend:

  • Screen all pregnant women for syphilis at their first prenatal visit. Women at higher risk should be rescreened at the beginning of their third trimester, again at delivery, and after exposure to an infected partner. This includes women with a history of sexually transmitted infection, incarceration, drug use, [or] multiple or concurrent partners, and those who live in areas with high prevalence. Women who were previously untested should also be screened again early in the third trimester and at delivery.
  • If your patient is diagnosed with syphilis, treat her immediately per the Centers for Disease Control and Prevention’s Treatment Guidelines with long-acting benzathine penicillin G IM, according to the stage of syphilis. Penicillin is the only treatment recommended in pregnancy; pregnant women with a documented penicillin allergy need to be desensitized and treated with penicillin.  Refer your patients elsewhere if injectable penicillin treatment is not available onsite for timely treatment. Follow up with your patient and document the treatment received. If a pregnant patient is lost to follow up before treatment could be documented, contact your local health department’s sexually transmitted disease (STD) program for assistance.
  • Some states require that providers report all cases of syphilis by stages and congenital syphilis to your local health department right away. Regardless of your state’s requirement, the CDC recommends reporting within 24 hours and also indicating pregnancy status.
  • Advise your patient to tell her sex partner(s) about the infection and encourage them to get tested and treated to avoid reinfection. It is helpful to explain to the patient that the health department may follow up to assist in getting prenatal care and partner services, such as notifying her partner(s) on her behalf. The patient may also follow up directly with the health department for assistance.  
  • Before discharging any mother or newborn infant from the hospital, make sure the mother’s serologic syphilis status was documented at least once during her pregnancy, including in the neonate’s medical record. If the test is positive, ensure that the mother and baby are evaluated appropriately and, if necessary, treated before discharge. Also, if a woman delivers a stillborn infant, she should be tested for syphilis.
  • Remember that the same tenets of STD prevention apply to pregnant women. Take a sexual history throughout the course of your patient's pregnancy, and talk with her about prevention methods.

See the Centers for Disease Control and Prevention’s Treatment Guidelines.

For more information, review the Guidelines for Perinatal Care.

American Congress of Obstetricians and Gynecologists
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