Syphilis screening in pregnancy: no time for complacency

Area of Science:

• Public Health
• Infectious Diseases
• Maternal-Fetal Medicine

Background:

• Congenital syphilis causes severe adverse pregnancy and infant outcomes globally.
• Recent years have seen a significant increase in congenital syphilis cases within high-income countries (HIC).
• Effective prenatal screening and prompt treatment are critical for healthy outcomes, particularly in equity-denied populations, yet implementation remains challenging.

Purpose of the Study:

• To review the challenges and strategies for implementing prenatal syphilis screening and treatment in high-income countries.
• To highlight the importance of reaching equity-denied populations with syphilis prevention services.
• To emphasize the need for collaborative approaches to combat the resurgence of congenital syphilis.

Main Methods:

• Review of current antenatal screening guidelines and implementation challenges.
• Identification of barriers to healthcare access for vulnerable populations in HIC.
• Exploration of innovative approaches like rapid testing and community-based outreach.

Main Results:

• Antenatal screening guidelines are universally recommended but difficult to implement.
• Poverty, housing instability, addiction, and mental health issues create significant barriers to care for key populations in HIC.
• Rapid/point-of-care tests, opportunistic screening, and community outreach are essential strategies to reach underserved groups.

Conclusions:

• The resurgence of congenital syphilis, particularly in HIC, necessitates effective interventions to reduce maternal and fetal morbidity and mortality.
• Addressing this preventable disease requires collaboration across government and health services.
• Involving key equity-denied populations and community-based organizations in intervention design is crucial for success.