Repeat Screening for Syphilis in the Third Trimester of Pregnancy

Hersh, Alyssa R.; Megli, Christina; Caughey, Aaron B.

doi:10.1097/aog.0000000000002795

Cited by 36 publications

(63 citation statements)

References 16 publications

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“…Whether and how to rescreen women at increased risk for syphilis both early in the third-trimester and again at delivery are important questions. Although cost effectiveness analyses have not favored universal third-trimester rescreening of all pregnant women, this calculation may require adjustment especially for communities with a high-prevalence of syphilis [ 18 , 19 ]. While the mothers of the infants described in these case reports both screened negative for syphilis initially, neither was rescreened at delivery despite residing in communities with a high-prevalence of syphilis and having histories of STIs.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Repeat screening can identify new infections in communities with high or rising syphilis prevalence, and has been shown to be a cost-effective public health prevention approach in some settings with higher syphilis prevalence or increasing prevalence in the community. 23,24 Although injectable penicillin is currently the only drug known to be effective in treating a syphilis-exposed fetus, alternatives to BPG during pregnancy are still commonly used in some countries, especially in the western Pacific (85% of countries), Africa (91%) and South East Asia (100%). Prior WHO guidance documents did not specifically caution against use of alternative treatment strategies, however, the 2016 and 2017 guidelines note that such strategies have not been proven effective in treating an exposed fetus.…”

Section: Discussionmentioning

confidence: 99%

Syphilis management in pregnancy: a review of guideline recommendations from countries around the world

Trinh

Leal

Mello

et al. 2019

Sexual and Reproductive Health Matters

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Guidelines can help healthcare practitioners manage syphilis in pregnancy and prevent perinatal death or disability. We conducted systematic reviews to locate guidance documents describing management of syphilis in pregnancy, 2003-2017. We compared country and regional guidelines with current World Health Organization (WHO) guidelines. We found 64 guidelines with recommendations on management of syphilis in pregnancy representing 128 of the 195 WHO member countries, including the two WHO guidelines published in 2016 and 2017. Of the 62 guidelines, 16 were for countries in Africa, 21 for the Americas, two for Eastern Mediterranean, six for Europe and 17 for Asia or the Pacific. Fifty-seven (92%) guidelines recommended universal syphilis screening in pregnancy, of which 46 (81%) recommended testing at the first antenatal care visit. Also, 46 (81%) recommended repeat testing including 21 guidelines recommended this during the third pregnancy trimester and/or at delivery. Fifty-nine (95%) guidelines recommended benzathine penicillin G (BPG) as the first-line therapy for syphilis in pregnancy, consistent with WHO guidelines. Alternative regimens to BPG were listed in 42 (68%) guidelines, primarily from Africa and Asia; only 20 specified that non-penicillin regimens are not proven-effective in treating the fetus. We identified guidance recommending use of injectable penicillin in exposed infants for 112 countries. Most guidelines recommended universal syphilis testing for pregnant women, repeat testing for high-risk women and treatment of infected women with BPG; but several did not. Updating guidance on syphilis testing and treatment in pregnancy to reflect global norms could prevent congenital syphilis and save newborn lives.

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“…Universal third trimester screening has been proposed to address the rising incidence, but cost-effective analyses are mixed. [29][30][31] Albright et al 30 calculated that a national rate of 17 cases of primary and secondary syphilis per 100 000 women or higher would make it cost-effective. The national prevalence in 2013 was 0.9 cases per 100 000 women, which did not meet this threshold.…”

Section: Figurementioning

confidence: 99%

“…This has risen to 2.3 cases per 100 000 women in 2017 nationally, with a rate of 4.6 cases per 100 000 in California. 2 Conversely, Hersh et al 29 in 2018 demonstrated strong evidence that universal third trimester screening would be cost-effective and improve maternal and neonatal outcomes. Further supporting this approach, in a 2019 CDC study, researchers found that approximately half of all pregnant women with syphilis and one-third of pregnant women with early syphilis did not report any highrisk behaviors.…”

Section: Figurementioning

confidence: 99%