Physician group calls for increased syphilis screening for pregnant women

The American College of Obstetricians and Gynecologists (ACOG) is recommending that all pregnant individuals be screened for syphilis three times during pregnancy. The recommendation comes as cases of newborns with syphilis has spiked in recent years. In it's practice advisory, ACOG calls for three screenings, once at the first prenatal care visit and again in the third trimester and again at birth.

A recent report from the Centers for Disease Control and Prevention that looks at sexually transmitted infections shows while cases of other STIs, like chlamydia and gonorrhea, have decreased or seen modest increases, syphilis has jumped 80% in the four years from 2018 to 2022.

"There has been a near eightfold increase in congenital syphilis cases in the last decade or more, and from a public health perspective, we recognize that obstetrician-gynecologists and other obstetric care clinicians play a critical role," said Christopher Zahn, MD, FACOG, interim CEO and chief of clinical practice and health equity and quality. "While we continue to endorse CDC's sexually transmitted infection treatment guidelines, ACOG's new guidance will no longer follow an individualized risk-based approach to testing later in pregnancy and instead help ensure more opportunities for testing and treatment."

Dr. Stacey Rizza, a Mayo Clinic infectious diseases specialist, says syphilis is a bacterial infection that is primarily transmitted through sexual contact. But she says it also can be transmitted from an expecting mother to the baby.

"So if a mother has syphilis, whether she knows it or not, while she's pregnant and is not diagnosed and treated, she can transmit that to her fetus, and the baby can be born with syphilis," says Dr. Rizza. This is also known as congenital syphilis, and according to the CDC report, cases of syphilis among newborns rose 183% between 2018 and 2022.

Dr. Rizza says the baby may be born asymptomatic, "but can go on to develop manifestations of syphilis later, within weeks, months or even years, after they're born. But, unfortunately, many times it causes abnormalities in the baby, even when they're born. They can have abnormalities in their liver and their spleen, they can have rashes, they can have abnormality in the structure of their face, in the brain, and particularly involving the eye."

If you are expecting or have recently given birth, and you suspect you may be infected, Dr. Rizza encourages testing as soon as possible. "So we can treat them during the pregnancy and prevent them from transmitting to the baby. And if somebody is born with syphilis, whether they have manifestations of it or not, we want to make sure we diagnose it quickly and treat it, so they don't go on to have further manifestations," she says.

Diagnosis is made with a blood test. If positive, treatment with the antibiotic penicillin has proven effective.