From the Journals

New syphilis cases for pregnant women rose 61% over 5 years

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Providers should be aware of local syphilis prevalence

I think this is an important topic of which pregnant women and their providers should be aware. It is possible the rising incidence is a result of increased screening and awareness; however, regardless of whether this is the case, it is important to identify the cases of congenital syphilis as preventable.

CDC
These findings provide good support for the current recommendation to screen all pregnant women, regardless of risk factors, at the first obstetric visit. Additionally, this highlights the flaw in rescreening only high-risk women in the third trimester because just less than half (49%) did not have any traditional risk factors.

It is important for providers to be aware of their local syphilis prevalence and regulations on prenatal syphilis screening because risk factor screening is likely inadequate in high prevalence areas, and likely first- and third-trimester screening for syphilis is more appropriate, given the effects of congenital syphilis and the ease of treatment.

Martina L. Badell, MD, is an assistant professor in the department of gynecology and obstetrics and maternal-fetal medicine at Emory University in Atlanta. She reported no relevant conflicts of interest.


 

FROM OBSTETRICS & GYNECOLOGY

Syphilis cases increased by 61% between 2012 and 2016 among pregnant women, and the proportion of syphilis cases was higher for women who were non-Hispanic black race and Hispanic ethnicity, according to research in Obstetrics & Gynecology.

“These findings support current recommendations for universal syphilis screening at the first prenatal visit and indicate that it may be necessary to include population context when determining whether to implement repeat screening during pregnancy,” Shivika Trivedi, MD, MSc, of the CDC Foundation and the Division of STD Prevention at the Centers for Disease Control and Prevention and colleagues wrote.

Dr. Trivedi and colleagues identified 9,883 pregnant women with reported syphilis in the CDC National Notifiable Diseases Surveillance System during 2012-2016. During that time, there was an increase in the number of female syphilis cases from 9,551 cases in 2012 to 14,838 cases in 2016 (55%), while there was an increase in the number of syphilis cases for pregnant women from 1,561 cases in 2012 to 2,508 cases in 2016 (61%). Of the risk factors reported for syphilis, 49% reported no risk factors within 12 priors before diagnosis, 43% said they had had at least one sexually transmitted disease, and 30% reported more than one sexual partner within the last year.

The greatest prevalence for syphilis was among women who were in their 20s (59%), located in the South (56%), and were non-Hispanic black (49%) or Hispanic (28%). However, researchers noted the rates of syphilis increased among all women between 18 years and 45 years and in every race and ethnicity group between 2012 and 2016. Early syphilis cases increased from 35% in 2012 to 58% in 2016, while late latent cases decreased from 65% in 2012 to 42% in 2016.

Researchers noted several limitations in the study, including case-based surveillance data, which potentially underreported the rates of syphilis, and a lack of pregnancy outcomes for pregnant women with syphilitic infections. However, they noted the data do show a trend of syphilis infections in pregnant women because the live birth rate “was relatively stable and did not fluctuate more than” 1.5% between 2012 and 2016.

“Through an increased awareness of the rising syphilis cases among pregnant women as well as these trend data, health care providers can be better informed to ensure they are following national guidelines and state policies for syphilis screening in pregnancy,” Dr. Trivedi and colleagues concluded.

The authors reported no relevant conflicts of interest.

SOURCE: Trivedi S et al. Obstet Gynecol. 2018. doi: 10.1097/AOG.0000000000003000.

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