Outcomes After Positive Syphilis Screening

Area of Science:

• Maternal and Child Health
• Infectious Disease Epidemiology
• Clinical Diagnostics

Background:

• Syphilis screening during pregnancy is crucial for preventing congenital syphilis.
• The impact of false positive (FP) screens and the effectiveness of treatment following screening are not well understood.

Purpose of the Study:

• To determine the false discovery rate of syphilis screening in pregnant populations.
• To evaluate the consequences of FP screens, including unnecessary treatment.
• To assess treatment adherence and outcomes for mothers and infants identified with syphilis.

Main Methods:

• Analysis of 75,056 pregnancies using laboratory criteria to classify syphilis screens as FP or true positive (TP).
• Calculation of false discovery rates for different screening algorithms and assays.
• Determination of treatment, clinical characteristics, and syphilis classifications for mothers and infants.

Main Results:

• A high false discovery rate of 0.83 was observed for syphilis screening.
• FP screens resulted in unnecessary treatment for 3 individuals (2 mothers, 1 infant).
• Congenital syphilis occurred in one infant due to delayed diagnosis and inadequate follow-up in a high-risk mother.

Conclusions:

• Syphilis screening limitations include a high FP rate leading to overtreatment.
• Inconsistent risk-based rescreening and suboptimal care for TP mothers can increase congenital syphilis risk.
• Improved management strategies are needed to optimize care and prevent adverse infant outcomes.