Screening for Syphilis Infection in Pregnant Women

Force, US Preventive Services Task; Curry, Susan J.; Krist, Alex H.; Owens, Douglas K; Barry, Michael J.; Caughey, Aaron B.; Davidson, Karina W.; Doubeni, Chyke A.; Epling, John W.; Kemper, Alex R.; Kubik, Martha; Kurth, Ann; Landefeld, C. Seth; Mangione, Carol M.; Phipps, Maureen G.; Silverstein, Michael; Simon, Melissa A.; Tseng, Chien-Wen; Wong, John B.

doi:10.1001/jama.2018.11785

Cited by 73 publications

(26 citation statements)

References 25 publications

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“…We observed that 44.7% of our cohort lost systemic opportunities to prevent early infection for TPA; which supports the efforts pointed to serial serological tests among all the pregnancy and the perinatal study of the infants [17,18]. Additionally, newborns whose serologic tests for syphilis are reactive and whose mothers were treated for syphilis should undergo a comprehensive evaluation consisting of a detailed physical examination and close follow-up at three/ four and six months of age until VDRL/RPR reactivity declines or disappears [19].…”

Section: Plos Neglected Tropical Diseasessupporting

confidence: 83%

Congenital syphilis in Argentina: Experience in a pediatric hospital

et al. 2021

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In spite of being preventable, Congenital syphilis (CS) is still an important, and growing health problem worldwide. Fetal infection can be particularly aggressive, but newborns can be asymptomatic at birth and, if left untreated, develop systemic compromise afterwards with poor prognosis. We analyzed 61 CS diagnosis cases between 1987–2019 presenting at the Buenos Aires Children’ Hospital. The distribution of cases showed a bimodal curve, with a peak in 1992–1993 and in 2014–2017. Median age at diagnosis was 2 months (IQ 1–6 months). The main clinical findings were: bone alterations (59%); hepatosplenomegaly (54.1%); anemia (62.8%); skin lesions (42.6%) and renal compromise (33.3%). Cerebrospinal fluid (CSF) was abnormal in 5 patients, normal in 45 and was not available for 11 patients. Remarkably, spinal lumbar puncture did not modify therapeutic decisions in any case. Between mothers, only 46% have been tested for syphilis during pregnancy and 60.5% patients had non-treponemal titers equal to or less than fourfold the maternal titer. Intravenous penicillin G was prescribed for all except one patient, who received ceftriaxone with good therapeutic response. During follow-up, 1.6% infants died, 6.5% had persistent kidney disorders and 1.6% showed bone sequelae damage. RPR titers decreased after treatment, reaching negative seroconversion in 43% subjects at a median of 26.4 months. Low adherence to follow up was observed due to inherent vulnerable and low-income population characteristics in our cohort. Our results highlight a rising tendency in cases referred for CS in our population with high morbidity related to delayed diagnosis. A good therapeutic response was observed. CS requires a greater effort from the health system to adequately screen for this disease during pregnancy, and to detect cases earlier, to provide an adequate diagnosis and treatment.

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Section: Plos Neglected Tropical Diseasessupporting

confidence: 83%

Congenital syphilis in Argentina: Experience in a pediatric hospital

et al. 2021

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“…The positive and negative predictive values depend on the population being tested and should be incorporated in the decision to treat. 35,36 Treponemal Evaluation of the placenta can be a useful adjunct to the diagnosis of syphilis. Grossly, the placenta appears hydropic and pale ( Figure 6).…”

Section: F I G U R E 4 Ultrasound Findings Of Fetal Syphilis A-e a mentioning

confidence: 99%

“…The diagnosis of syphilis in the neonate is similar to that used in the adult. Darkfield microscopy, PCR, or immunohistochemical stains of lesions, bodily fluid or neonatal tissue, including placenta can all be F I G U R E 5 A, Timeline of positivity for each serologic test component and B, comparison of traditional and reverse sequence algorithm 36,37,39 [Colour figure can be viewed at wileyonlinelibrary.com] used to confirm syphilis but are often not immediately available. 41 Similar to adults, the majority of neonates with CS will be asymptomatic.…”

Section: Neonatal Diagnosismentioning

confidence: 99%

Congenital syphilis: A contemporary update on an ancient disease

2020

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Congenital syphilis (CS) rates reached a 20-year high in the United States in 2018. Unlike previous years, most babies diagnosed with CS were born to mothers who received prenatal care, indicative of the need for better provider education and guideline adherence. Current rates suggest that screening for syphilis should be performed at the first prenatal care visit and twice during the third trimester. There are two diagnostic algorithms available for use in the United States (traditional and reverse) and providers must understand how to perform each algorithm. Treatment should be administered according to stage of syphilis per Centers for Disease Control recommendations with best neonatal outcomes seen when treatment is initiated >30 days before delivery. Benzathine Penicillin G remains the only recommended treatment of syphilis during pregnancy. In viable pregnancies, a pretreatment ultrasound is recommended to identify sonographic evidence of fetal infection and treatment should be initiated with continuous fetal monitoring to evaluate for the Jarisch-Herxheimer reaction which can cause preterm labor and fetal distress. After adequate syphilotherapy, a fourfold decline in maternal nontreponemal titers may not be observed by delivery and does not correlate with rates of CS.

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“…The optimal approach to screening pregnant women for syphilis has not been established. Advantages and disadvantages to both the traditional and reverse-screening approach exist with regard to cost, laboratory throughput, false-positive rates, ability to discern previous or latent infection, and improved sensitivity for diagnosis of acute infection [ 7 , 15 , 17 ]. In addition, where syphilis PCR is available, lesions should be swabbed and tested for confirmatory diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…If untreated during pregnancy, maternal syphilis may result in fetal demise, or congenital infection, which may lead to severe physical and neurological disability or newborn death [ [3] , [4] , [5] , [6] ]. Key to prevention is screening pregnant women for syphilis at the initial prenatal visit, and if at increased risk, again in the third-trimester and at delivery [ 1 , 7 , 8 ]. The State of Ohio where our cases originated, requires syphilis screening of all pregnant women at the first antenatal visit but does not require repeat testing later in pregnancy nor at delivery [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Congenital syphilis: Missed opportunities and the case for rescreening during pregnancy and at delivery

O’Connor

Gonzalez

Esper

et al. 2020

IDCases

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Highlights Two infants treated for syphilis born to at risk mothers who were not rescreened at delivery are described. Screening for syphilis at the first prenatal visit is the standard of care but may fail to detect late term acquisition of maternal infection. In high risk populations, rescreening for syphilis should be performed during pregnancy both early in the third trimester and again at delivery. Early maternal syphilis may be recognized using the treponemal first reverse-screening algorithm.

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Screening for Syphilis Infection in Pregnant Women

Abstract: The USPSTF recommends early screening for syphilis infection in all pregnant women. (A recommendation).

Cited by 73 publications

References 25 publications

Congenital syphilis in Argentina: Experience in a pediatric hospital

Congenital syphilis in Argentina: Experience in a pediatric hospital

Congenital syphilis: A contemporary update on an ancient disease

Congenital syphilis: Missed opportunities and the case for rescreening during pregnancy and at delivery

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