National Center for Health Research’s Public Comments on
the USPSTF’s Draft Recommendation Statement- Syphilis Infection in Pregnancy: Screening
Thank you for the opportunity to share our views regarding USPSTF’s draft recommendation of syphilis screening in pregnant women. The National Center for Health Research (NCHR) is a nonprofit think tank that conducts, analyzes, and scrutinizes research, policies, and programs on a range of issues related to health and safety. We do not accept funding from companies that make products that are the subject of our work.
Syphilis screening in pregnant women is an important public health issue because untreated syphilis can cause congenital syphilis, stillbirth, fetal loss, neonatal death, preterm birth, and low birth weight.  Early screening, detection, and treatment is always critical for the health of the mother and the fetus, but is of particular importance now due to the rise in syphilis rates. In 2016, the incidence of congenital syphilis was 15.7 cases per 100,000 live births, which is the highest rate since 2001.  There are sizeable disparities in disease in women across demographics and geographic areas, including an alarming eight-fold higher incidence of congenital syphilis in black women compared to white women. Those data were not stratified by socio-economic status or other demographic characteristics. Since the USPSTF’s recommendation in 2009, new research reinforces the benefits of syphilis screening in pregnant women.
We agree with the USPSTF recommendation for screening as early as possible when patients first present for prenatal care. As discussed in the recommendation and review, studies have shown that the incidence of congenital syphilis and adverse pregnancy outcomes are reduced when women are screened and treated for syphilis, particularly when it occurs early in the pregnancy.  For example, a study evaluating the 10 years after implementation of free screening in Shenzhen, China found that while the increase in the number of women screened was relatively small, the incidence of congenital syphilis decreased by over 90% and fetal loss in pregnant women with syphilis decreased over 80% to only 3% of infected women. In addition, early screening and treatment reduces the risk of infant morbidity and mortality much more than at later stages. A recent systematic review of 54 studies found that pregnant women treated for syphilis in the third trimester only reduced the incidence of stillbirth and fetal loss from 23% to 18% when compared to pregnant women with untreated syphilis.
The harms associated with syphilis screening in pregnant women are primarily associated with the possibility of incorrect test results. False positives can cause unnecessary stress, anxiety, and overtreatment. False negatives can result in negative pregnancy and fetal outcomes due to delayed treatment. However, the two-step screening process greatly reduces this risk. In addition, syphilis can be effectively treated with penicillin. Therefore, the benefits from screening outweigh the risks of false results or treatment.
The prevention of congenital syphilis and other negative fetal outcomes outweighs the risks of false results or unnecessary treatment with penicillin, especially when screening occurs early in the pregnancy. Overall, we agree with the USPSTF draft recommendation for syphilis screening in pregnant women.
Thank you for the opportunity to comment on this important issue.
NCHR can be reached through Stephanie Fox-Rawlings at email@example.com.
- Draft Recommendation Statement: Syphilis Infection in Pregnant Women: Screening. U.S. Preventive Services Task Force. February 2018. https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/syphilis-infection-in-pregnancy-screening1
- Draft Evidence Review: Syphilis Infection in Pregnant Women: Screening. U.S. Preventive Services Task Force. February 2018. https://www.uspreventiveservicestaskforce.org/Page/Document/draft-evidence-review/syphilis-infection-in-pregnancy-screening1
- Centers for Disease Control and Prevention. 2016 Sexually Transmitted Diseases Surveillance. https://www.cdc.gov/std/stats16/default.htm
- Qin JB, Feng TJ, Yang TB, et al. Synthesized prevention and control of one decade for mother-to-child transmission of syphilis and determinants associated with congenital syphilis and adverse pregnancy outcomes in Shenzhen, South China. Eur J Clin Microbiol Infect Dis. 2014;33(12):2183-2198. https://www.ncbi.nlm.nih.gov/pubmed/24973132
- Qin J, Yang T, Xiao S, Tan H, Feng T, Fu H. Reported estimates of adverse pregnancy outcomes among women with and without syphilis: a systematic review and metaanalysis. PloS one. 2014;9(7):e102203. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4099012/