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The U.S. Preventive Services Task Force (USPSTF) in a recommendation statement published this week in JAMA reaffirmed its highest recommendation for early and universal syphilis screening in pregnancy, which aligns with its 2018 guidance. The recommendation emphasizes screening for all pregnant adolescents and adults at the first prenatal opportunity, regardless of individual risk factors, using both treponemal and non-treponemal tests. The directive is based on high-certainty evidence that syphilis screening during pregnancy provides a substantial net benefit by preventing adverse outcomes associated with congenital syphilis, such as: premature birth; low birth weight; stillbirth; neonatal death; congenital anomalies; and meningitis. Against the backdrop of this recommendation, the United States recorded 3,882 cases of congenital syphilis in 2023—the highest number in nearly 30 years—with 279 stillbirths or neonatal/infant deaths attributed to syphilis. The USPSTF maternal syphilis screening recommendation from 1996 has logged 4 reaffirmation updates in 2004, 2009, 2018, and now again this year.
Additional testing in third trimester: In a related editorial, experts note that “the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists currently recommend universal syphilis screening in the first trimester and additional testing in the third trimester and at delivery for mothers in higher-risk settings.” The USPSTF did not suggest repeat screening because of the lack of evidence, however.