Targeted routine screening may identify pregnant women in need of syphilis treatment

Key takeaways:

• Targeted routine syphilis screening may identify pregnant women who need syphilis treatment.
• History of syphilis and prenatal care are the most robust screening metrics to use in this patient population.

SAN FRANCISCO — Targeted routine syphilis screening may help identify pregnant women in the first and third trimester in need of treatment compared with universal screening, researchers reported.

“Prior to the intervention of universal screening in labor and delivery, targeted screening was up to providers’ discretion. Whatever the individual provider thought was a risk factor dictated whether or not they screened for syphilis,” Elizabeth Shirazi, MD, a fourth-year resident in the department of obstetrics and gynecology at the University of California, Davis, said during a poster presentation at the ACOG Annual Clinical & Scientific Meeting.

Shirazi and colleagues conducted a chart review after implementation of syphilis immunoglobulin G and immunoglobulin M in the routine admission lab order sent for universal screening at the University of California, Davis. Researchers assessed electronic medical records for all pregnant women who received prenatal care and underwent syphilis screening in the first and third trimester at 6 months before and after intervention.

Six months before adding routine screening, 282 women were screened for syphilis, of whom 7.4% tested positive. Of women with syphilis, 66% had little or no prenatal care, 66% had syphilis history, 33% had a concurrent sexually transmitted infection (STI) diagnosis, 76% had substance use, 57% had unstable housing and 10% had incarceration history.

After 6 months of the intervention, 985 women were screened for syphilis, of whom 1.8% tested positive. Of those who tested positive after the intervention, 66% had little or no prenatal care, 80% had syphilis history, 40% had a concurrent STI diagnosis, 80% had substance use, 86% had unstable housing and 33% had incarceration history.

Researchers observed three false-positive tests 6 months after implementing targeted routine syphilis screening and no false positives before the implementation.

“In looking forward, we think that implementing a more clearly defined targeted screening method on our labor and delivery would likely be sufficient to, hopefully, find most of the cases of untreated syphilis,” Shirazi said. “Including metrics like history of syphilis [and] no or scant prenatal care would likely be the two most robust screening metrics that we thought we should use.”