Screening for Syphilis Infection During Pregnancy: US Preventive Services Task Force Reaffirmation Recommendation Statement

Published in JAMA. Here is a link to the article.

Regenstrief Institute authors: Sarah Wiehe, MD, MPH

The U.S. Preventive Services Task Force (USPSTF) has reaffirmed its recommendation for early, universal screening for syphilis infection in all pregnant individuals, regardless of risk factors. This reaffirmation is based on strong evidence that screening during pregnancy provides substantial net benefit in preventing congenital syphilis and its associated adverse outcomes.

Congenital syphilis is a serious and preventable condition that can lead to stillbirth, neonatal death, and severe infant complications such as bone deformities, neurological damage, and organ enlargement. In 2023, the United States recorded 3,882 cases of congenital syphilis, including 279 stillbirths and infant deaths—marking the highest rate in over three decades.

The USPSTF recommends syphilis screening as early as possible in pregnancy and, if missed, at the first opportunity thereafter. The screening process involves both treponemal and nontreponemal blood tests to enhance diagnostic accuracy. The standard treatment remains parenteral penicillin G, with desensitization protocols advised for those with allergies.

While minor harms such as false positives and medication reactions are possible, they are outweighed by the benefits of early detection and treatment. The Task Force acknowledges the lack of new evidence supporting additional screening later in pregnancy but emphasizes the need for more research in this area, particularly given racial and ethnic disparities in congenital syphilis rates.

This recommendation aligns with guidance from the CDC, ACOG, WPSI, and AAP, and underscores the critical importance of prenatal care in reducing preventable infant morbidity and mortality. The USPSTF remains committed to evidence-based recommendations that promote maternal and child health nationwide.

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