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The Impacts and Importance of Prenatal Syphilis Screening

August 24, 2022

Editor’s Note: Dr. Nicole Byram is a pediatric resident. She plans to practice primary care pediatrics with particular interests in newborn medicine and community involvement. I am pleased that she was interested in writing this blog about a topic that we encounter daily.

-Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics

Nothing can compare with meeting an hours-old healthy newborn baby and experiencing the joy of the baby’s arrival alongside the family. In the unique setting of caring for newborns, the health history of the pregnant parent plays an undeniably important role. Pediatric healthcare providers must become familiar with recommendations for prenatal screening and care.

Unfortunately, there are some situations in which we must inform happy new parents and relatives that the precious new baby might have an infection, a congenital condition, or another other disease. In the most frustrating scenarios, a baby has an illness that could have been prevented with appropriate treatment or care, and one such condition is congenital syphilis.

All pregnant persons should have prenatal testing for syphilis, as timely recognition and treatment can prevent adverse effects to the child.

This week, Pediatrics is early releasing an article by O’Connor and colleagues from the Center for Pediatric Infectious Diseases at the Cleveland Clinic, which reports the results of a comprehensive study detailing outcomes of syphilis testing during pregnancy (10.1542/peds.2022-056457). Their study included data from 75,056 pregnancies between 2014 and 2021 and evaluated the syphilis screens, test results, treatments, and diagnoses.

The authors find that there are many false positive syphilis screening tests – 83% in this study! Fortunately, these false positive tests cause little harm in the form of unnecessary testing or treatment. In the accompanying invited commentary, Dr. Jessica Williams and colleagues from the Ohio State University, Columbus Public Health, and University of Connecticut discuss how syphilis screening tests prioritize sensitivity, so the false positive rate is expected to be high, particularly in areas with a low prevalence of syphilis (10.1542/peds.2022-057927).

More importantly however, when responses to the true positive tests are studied, the authors of this study report a lack of appropriate follow-up for both parents and infants and inconsistent use of pregnancy risk-based re-screening syphilis tests, which can result in missed re-infections and treatment failures.

The authors of the commentary highlight how current recommendations call for documentation of one syphilis test during each pregnancy. However, because the timing of the test can vary, tests performed early in pregnancy might miss untreated infections or infections acquired later in the prenatal period. Pregnant persons who are at risk for re-infection or relapse should be rescreened at delivery. Indeed, O’Connor et al note that several newborns in their study had congenital syphilis, which would have been detected earlier if their parent (who met criteria for repeat screening later in pregnancy) had repeat syphilis testing at the time of delivery. Improving rates of detection and treatment of congenital syphilis requires a team effort from both obstetricians and pediatricians.

As we spend time caring for newborns and monitoring their health closely as they grow, we cannot forget the impact of prenatal health on babies and must ensure we are aware of prenatal test results and their implications. I highly encourage you to read this article and the accompanying commentary to raise your awareness of the impacts and significance of prenatal syphilis testing.

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