As the number of cases of newborns with syphilis rises rapidly across the United States, the leading reproductive physicians group in the country is strengthening its recommendations for syphilis screenings for pregnant patients.
The American College of Obstetricians and Gynecologists is recommending that pregnant women be screened for syphilis three times during pregnancy: during the initial prenatal visit, during the third trimester, and at birth.
“There has been a near eightfold increase in congenital syphilis cases in the last decade or more, and from a public health perspective, we recognize that obstetrician-gynecologists and other obstetric care clinicians play a critical role,” Christopher Zahn, CEO and chief of clinical practice, said in a press release on Thursday.
The Centers for Disease Control and Prevention in November announced that in 2022 there were over 3,700 infants diagnosed with congenital syphilis, or syphilis spread from the mother during pregnancy. This is 10 times the rate of infection in 2012.
The overall infection rate of syphilis has also rapidly risen in recent years, increasing by nearly 32% between 2020 and 2021.
In January, the CDC issued guidance for physicians and healthcare providers regarding personalized risk management for screenings for sexually transmitted infections. The agency strongly recommended that providers seek innovative solutions to overcome socioeconomic barriers that hinder access to STI screenings and other reproductive health measures.
ACOG’s new recommendations, however, break from the CDC’s more localized approach.
“While we continue to endorse CDC’s sexually transmitted infection treatment guidelines, ACOG’s new guidance will no longer follow an individualized risk-based approach to testing later in pregnancy and instead help ensure more opportunities for testing and treatment,” Zahn said.
Zahn said a key obstacle in lowering rates of syphilis is the persistent shortage of the specific type of the antibiotic penicillin, sold as Bicillin L-A. The Food and Drug Administration has granted permission for the temporary use of another penicillin variation, Extencilline, which is used in other countries to mitigate the effects.
American Indian and Alaska Native populations have the highest rates of congenital syphilis, occurring in nearly 645 out of 100,000 live births. Native Hawaiian and Pacific Islander populations have the second highest rate at 404 per 100,000, followed by black Americans at 215 per 100,000.
Congenital syphilis is a leading cause of stillbirth or infant deaths. In 2022, the disease resulted in 213 stillbirths and 51 infant deaths.
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The CDC estimates that 90% of the cases of congenital syphilis in 2022 could have been prevented with testing and treatment during pregnancy.
“Congenital syphilis can have devastating effects,” Zahn said. “We know that a majority of cases can be prevented, so additional routine screening during pregnancy is one important step that clinicians can take that could potentially be lifesaving.”