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Prenatal Syphilis Screening

NOMINATED TOPIC | June 3, 2022

1. What is the decision or change (e.g. clinical topic, practice guideline, system design, delivery of care) you are facing or struggling with where a summary of the evidence would be helpful?

We are interested in interventions to improve prenatal syphilis screening and prevent congenital syphilis. A summary of evidence would be helpful in developing a future evidence-based guideline that provides practitioners with information on the most effective interventions used to improve prenatal screening and prevent congenital syphilis.


1. What is the most effective repeat prenatal screening strategy to prevent congenital syphilis?
Population: pregnant individuals
Interventions and Comparators: screening approaches (universal repeat third trimester and intrapartum screening vs risk-based third trimester and intrapartum screening vs other screening approaches vs no screening)
Outcomes: maternal morbidity, rates of maternal syphilis, rates of congenital syphilis, rates of other sexually transmitted infections, fetal/neonatal morbidity and mortality

2. What are effective state/local prenatal screening implementation strategies?
Population: pregnant individuals (sub populations could include pregnant individuals by geographic region)
Interventions and Comparators: implementation strategies, funding resources, integration and relationship to state health departments, reporting requirements
Outcomes: maternal morbidity, rates of maternal syphilis, rates of congenital syphilis, rates of other sexually transmitted infections, fetal/neonatal morbidity and mortality

2. Why are you struggling with this issue?

Current guidance1,2,3 recommends all pregnant women should be screened serologically for syphilis infection at the first prenatal visit. Women who are at high risk of syphilis, live in areas of high syphilis morbidity, or are previously untested should be screened again early in the third trimester (at approximately 28 weeks of gestation) and again at delivery, as well as after exposure to an infected partner. Some states require all women to be screened at delivery.3 For some institutions and practices where many patients may be at higher risk of acquiring syphilis and should therefore be rescreened during the third trimester and at delivery, the benefits of implementing these resource-intense risk-based processes may not be clear. There ma y also be a preference to implement universal repeat screening. Additionally, according to the Centers for Disease Control and Prevention (CDC), the rate of congenital syphilis in the United States increased between 2012 and 2019.4 This suggests that there may be either a more optimal approach to prenatal screening or that better strategies are needed to implement prenatal screening. Since implementation strategies to prevent congenital syphilis vary across the United States, a systematic review could help identify successful implementation strategies as well as reasons for their success.

1US Preventive Services Task Force, Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW Jr, Kemper AR, Kubik M, Kurth AE, Landefeld CS, Mangione CM, Phipps MG, Silverstein M, Simon MA, Tseng CW, Wong JB. Screening for Syphilis Infection in Pregnant Women: US Preventive Services Task Force Reaffirmation Recommendation Statement. JAMA. 2018 Sep 4;320(9):911-917.
2Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep 2021;70(RR-4):1-187.
3American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG). (2017). Guidelines for Perinatal Care (8th edition).
4CDC. Sexually transmitted disease surveillance 2019 [Internet]. Atlanta GA: US Department of Health and Human Services, CDC; 2021.

3. What do you want to see changed? How will you know that your issue is improving or has been addressed?

We want to see evidence-based findings that can be integrated into clinical guidance with practical, evidence-based recommendations to help clinicians most effectively prevent and treat maternal and congenital syphilis. We will know the issue is improving when rates of maternal and congenital syphilis and adverse maternal and fetal outcomes associated with congenital syphilis decrease.

4. When do you need the evidence report?

Mon, 06/03/2024

5. What will you do with the evidence report?

The evidence report will be used by the American College of Obstetricians and Gynecologists (ACOG) to potentially develop a future clinical consensus or clinical practice guideline document. Therefore, an evidence report will help support development of future evidence-based recommendations used by practitioners to care for their patients, treat and prevent maternal syphilis, and ultimately prevent congenital syphilis.

Optional Information About You

What is your role or perspective? Professional Organization

If you are you making a suggestion on behalf of an organization, please state the name of the organization? American College of Obstetricians and Gynecologists (ACOG)

May we contact you if we have questions about your nomination? Yes

Page last reviewed June 2022
Page originally created June 2022

Internet Citation: Prenatal Syphilis Screening. Content last reviewed June 2022. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD.

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