ACOG recommends More Testing During Pregnancy prompted by Rising Syphilis Cases

Syphilis numbers are on the rise in Tennessee: In women, the number of cases has risen 311%, from 290 cases in 2017 to 1,191 in 2022.

"Part of the issue is the lack of timely testing in pregnancy and adequate treatment during pregnancy,” said Soha Patel, MD, MSPH, assistant professor in the department of Obstetrics and Gynecology. “Another issue is regarding the shortage of the first line injectable penicillin for treatment of syphilis.”

Syphilis is a sexually transmitted infection (STI) passed through unprotected oral, anal or vaginal sex, and can be detected through a blood test. When found and treated early with antibiotics, syphilis is curable. Untreated syphilis can cause deafness, blindness and irreversible heart and brain damage. Syphilis can also be passed from mother to unborn baby at any time.

“We are seeing babies with syphilis and syphilis exposure, and it could have a lifelong effect on the child if not treated, including mental retardation, deafness, blindness, abnormal detention, bony abnormalities, growth problems and more,” said Walter Dehority, MD, MSc, associate professor in the department of Pediatrics, division of Infectious Diseases. “We treat congenital syphilis with 10 days of IV penicillin. Many infants born to women with untreated syphilis will require x-rays of the bones, an eye exam, a lumbar puncture and blood work just to evaluate for congenital syphilis infection, even if they are not treated.”

According to the Tennessee Department of Health, syphilis increases risk of preterm birth and is a major cause of stillbirth: Up to 40% of babies of mothers with untreated syphilis are stillborn or die in infancy.

The American College of Obstetrician and Gynecologists (ACOG) updated their guidance-which previously recommended third trimester testing only for those in communities with high syphilis rates or have been at risk during pregnancy-to three screenings for every pregnant person.

“Per ACOG’s most recent recommendation, because of the rapidly increasing rates of congenital syphilis, prenatal providers should screen all pregnant individuals for syphilis at the first prenatal care visit, followed by universal rescreening during the third trimester and at birth,” Patel said.

VUMC is in alignment with these recommendations and has rolled out the new requirement in inpatient and outpatient settings.

“Timely diagnosis and treatment are key to reducing syphilis rates, and yet we are currently facing several challenges, including treatment shortages, lack of access to prenatal care, and the stigma that surrounds sexually transmitted infections,” said Christopher Zahn, MD, FACOG, interim ACOG CEO and chief of clinical practice and health equity and quality. “Congenital syphilis can have devastating effects. 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.”