Syphilis Screening During Pregnancy
Indiana is experiencing a significant increase in the number of women with infectious syphilis. Between 2018 and 2020, early syphilis (less than one year’s duration) increased 169% among women. Over the past three years, syphilis cases among women have more than doubled (62 early cases in 2018 compared with 167 early cases in 2020); preliminary 2021 case counts have already surpassed 2020 totals, with 229 cases as of the end of August 2021.
The number of syphilis cases among pregnant women also more than doubled from January to August 2021, compared with the same timeframe in 2019 (from 25 cases to 57 cases). These increases are most pronounced in northern and central Indiana; increases are also more pronounced among those who are Black/African-American, Hispanic, and Other/Multi-Races.
RECOMMENDATIONS FOR PROVIDERS:
Screening and Treatment Recommendations for Pregnant Women and Women in Childbearing Years to Prevent Congenital Syphilis
Indiana healthcare providers are asked to be especially vigilant about screening pregnant women for syphilis according to clinical and public health recommendations (at first trimester or first prenatal visit; between 28-32 weeks gestation; and at delivery). It is also imperative that adequate treatment (2.4 MU Bicillin, IM) be administered to the mother as quickly as possible to avert a potential congenital syphilis (CS) birth, with at least the first dose (depending on stage of syphilis) needing to be administered no less than 30 days prior to delivery for CS prevention. Pregnant women with penicillin allergies should undergo desensitization, as Bicillin is the only recommended treatment for syphilis during pregnancy; the CDC’s full STD Treatment Guidelines can be viewed at this link: https://www.cdc.gov/std/treatment-guidelines/default.htm.
Recent studies in the U.S. have shown that syphilis screening of all pregnant women presenting for any care in hospital emergency departments is an effective method of identifying syphilis cases. IDOH strongly encourages hospitals to consider implementing this strategy.
Screening Recommendations for Men and Others to Prevent Congenital Syphilis
Pregnant women with syphilis often present with few identifiable risk factors. In Indiana, the only risk for syphilis for approximately one-third of pregnant women is their steady male partner. Males under age 29, adults of any age with a history of incarceration or exchanging money or drugs for sex, and those in high-prevalence areas or populations are recommended to be screened annually for syphilis, according to CDC and the US Preventive Services Task Force . Healthcare providers should ask male patients if any of their female partners could be pregnant to ensure they are tested and treated. Local DIS are available to conduct partner services to help facilitate this. Please see this link for contact information.
Read the full health alert here (PDF file).