Syphilis screening in pregnancy sometimes sub par

By Megan Rauscher

NEW YORK (Reuters Health) - Few pregnant women are fully screened for syphilis in accordance with current guidelines, hints a review of records of roughly 1,900 women from four hospitals in Miami-Dade County, Florida.

"Although 83 percent of pregnant women in Miami-Dade County during 2001 were screened for syphilis during their first prenatal care visit," Dr. Mary Jo Trepka said, "only 11 percent were screened a second time before delivery as is recommended, given that Miami-Dade County has a high incidence of syphilis infections."

She stressed that syphilis screening is important "so that women who are infected with syphilis can be treated and thus prevent infection of an unborn child."

A pregnant woman with untreated syphilis infection may transmit the infection to her baby while it's still in the womb, which can result in miscarriage, stillbirth, fetal death, prematurity and deafness, as well as other serious complications.

Current guidelines recommend syphilis screening during the first trimester for all women and additional screening during the third trimester and at delivery for women at high risk for syphilis or living in communities where syphilis is prevalent.

"Only one screening test during prenatal care -- offered at the first prenatal visit --is recommended for women who live in communities with low rates of syphilis and who are not at high risk of syphilis," explained Trepka, from Florida International University, Miami. "If Miami-Dade County were such a community, most of the women would have been screened appropriately given that 83 percent had been screened at least once during prenatal care."

Most of the women who were not screened a second time had had regular prenatal care visits. Therefore, it appears that healthcare providers were not performing the second screening test. "We found that women who were obtaining prenatal care in private clinics as opposed to public clinics were less likely to be screened twice as recommended," Trepka said.

While pubic health measures are needed to improve screening practices of health care providers, Trepka puts some of the onus on women. "I do think that it is in a person's best interest to be informed about their health care," she said.

Trepka and colleagues report their study in the November issue of Sexually Transmitted Diseases. In a commentary, two doctors from the Centers for Disease Control and Prevention say congenital syphilis is a "sentinel public health event because of its devastating consequences and persistence throughout the United States."

The current study, note Drs. John Beltrami and Stuart Berman, suggests that an "unacceptably low proportion" of pregnant women are screened according to guidelines that have been in place for nearly 20 years.

SOURCE: Sexually Transmitted Diseases, November 2006.