The U.S. Preventive Services Task Force (USPSTF) has reaffirmed its recommendation for universal syphilis screening in early pregnancy, citing strong evidence that early detection can prevent serious health complications for newborns.
In 2023, 3,882 U.S. babies were born with congenital syphilis—the highest number in 30 years. About 90% of these cases were preventable through timely diagnosis and treatment. Of those affected, 279 died before or shortly after birth. The infection increases the risk of premature birth, low birth weight, bone deformities, and other serious health issues.
Rates of congenital syphilis were highest among Native American and Alaska Native women (680 cases per 100,000 live births), followed by Native Hawaiian/Pacific Islander, Black, and Hispanic women. Experts attribute these disparities to a mix of social, economic, and demographic factors.
The USPSTF advises screening all pregnant women early, regardless of risk level or previous testing. Non-treponemal tests like RPR or VDRL are typically used first, followed by confirmatory treponemal tests such as the TP-PA test. While point-of-care tests exist, they are not fully validated for routine use.
Treatment with penicillin G is the standard for syphilis during pregnancy. Women allergic to penicillin should undergo desensitization to receive the medication. Side effects may include allergic reactions or the Jarisch-Herxheimer reaction, a temporary flu-like illness following treatment.
Rescreening later in pregnancy remains debated. Some cases of congenital syphilis occur despite an initial negative test. The CDC and other health organizations recommend rescreening high-risk women at 28 weeks and at delivery. ACOG supports rescreening all pregnant women. However, the USPSTF found insufficient evidence to make a universal recommendation and calls for more research.
Clinicians are urged to consider local syphilis rates and follow state-specific screening laws.
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