Surge in Congenital Syphilis Cases Prompts New Screening Guidelines for Pregnant Women

The American College of Obstetricians and Gynecologists (ACOG) has issued new guidance recommending that all pregnant patients be screened for syphilis three times during pregnancy - at the first prenatal visit, during the third trimester, and again at birth. This change comes in response to a surge in congenital syphilis cases in the United States, which have reached the highest levels in more than 30 years.

Previously, ACOG had only recommended one syphilis test in the third trimester for women considered at risk or living in high-rate communities. However, this risk-based approach has been criticized for missing cases. The Centers for Disease Control and Prevention (CDC) reported that more than 3,700 babies were born with congenital syphilis in 2022, the most in over three decades. Nearly 90% of these cases could have been prevented with timely screening and treatment.

Why this matters: Congenital syphilis can lead to devastating consequences for newborns, including stillbirths, infant deaths, and birth defects. The surge in cases highlights the urgent need for improved prevention efforts and increased access to prenatal care.

Syphilis infections during pregnancy are generally treated with penicillin. However, drug shortages, particularly for penicillin, have contributed to the rising syphilis cases. The FDA has granted temporary approval for an alternative drug, Extencilline, to address the shortage until domestic production of penicillin returns to normal levels.

In response to the growing epidemic, some states are taking additional measures. The Colorado Department of Public Health and Environment recently issued a statewide public health order expanding access to syphilis testing during pregnancy. Medical providers in Colorado must now offer testing at greater frequency throughout pregnancy, and correctional facilities must provide testing.

Health officials emphasize the need to take this issue seriously and improve diagnostic and treatment efforts to address the preventable rise in congenital syphilis cases. "We need to make sure that all pregnant people are screened at least three times during pregnancy," said Dr. Ina Park, an obstetrician-gynecologist and member of ACOG's Infectious Diseases Committee. "This is a completely preventable condition if caught and treated early."

Key Takeaways

• ACOG recommends 3 syphilis tests during pregnancy to address surge in congenital cases.
• Over 3,700 babies born with congenital syphilis in 2022, 90% preventable with timely screening.
• Congenital syphilis can lead to stillbirths, infant deaths, and birth defects.
• Penicillin shortages contribute to rising syphilis cases, FDA approves alternative drug.
• Some states expand access to syphilis testing during pregnancy to address the epidemic.