NCHR Comment on the USPSTF’s Draft Recommendations for Syphilis Screening in Pregnancy

National Center for Health Research’s Public Comments on
the USPSTF’s Draft Research Plan for Syphilis Infection in Pregnancy: Screening

Thank you for the opportunity to express our views on the draft recommendations for screening for syphilis infection in pregnant women. This is an important public health issue in the U.S. because syphilis can cause stillbirth or death in newborns born to women with untreated syphilis, as well as low birth weight, premature birth, and abnormal bone and brain development.[1] In the primary and secondary stages, syphilis symptoms may go unnoticed or can be mild, which means screening may be necessary to identify women and fetuses at risk.[2]

The National Center for Health Research is a nonprofit research center that analyzes and reviews research on a range of health issues, with particular focus on which prevention strategies and treatments are most effective for which patients and consumers. We do not accept funding from pharmaceutical companies and have no financial ties to this issue.

USPSTF last reviewed the literature and provided recommendations for screening in 2009, giving screening an “A” grade. However, over time new evidence or changing medical practice could alter the benefit to risk ratio.[3]

We appreciate and support the USPSTF’s efforts to review and reassess recommendations based on evolving research. As the USPSTF identifies relevant research studies to provide a basis for the review and subsequent recommendation, we urge it to consider the following issues.

In the literature and in clinical practice, the use of the term and application of two-step screening for syphilis using a nontreponemal and treponemal test can differ – often one of the two tests is only used for confirmation of a positive result. Clarifying the intended definition(s) of this screen should help to prevent unintended exclusion of studies, which could inform the review and subsequent recommendation.

Disparities between demographic subgroups can influence the benefit/risk comparisons. For example, in the U.S. the rates of congenital syphilis are dramatically higher for some demographic groups,[4] and so the research review and subsequent recommendations will be more beneficial if they are based on diverse populations in the U.S. or similar countries.

In conclusion, we strongly support the USPSTF’s ongoing effort to provide screening recommendations based on current, quality scientific studies. We hope the review will cover differences in clinical practice and the diversity of populations to help the USPSTF make meaningful recommendations for syphilis screening in pregnant women.

For questions or more information, please contact Stephanie Fox-Rawlings at

  1. Congenital Syphilis – CDC Fact Sheet. U.S. Center for Disease Control. February 2017.
  2. Syphilis – CDC Fact Sheet. U.S. Center for Disease Control. June 2017.
  3. Final Update Summary: Syphilis Infection in Pregnancy: Screening. U.S. Preventive Services Task Force. July 2015.
  4. Sexually Transmitted Disease Surveillance 2015. Centers for Disease Control and Prevention. Atlanta: U.S. Department of Health and Human Services. 2016.