Prenatal Syphilis Screening Mandates and Maternal Syphilis Case Detection

Area of Science:

• Public Health
• Epidemiology
• Infectious Disease Prevention

Background:

• Congenital syphilis rates are rising in the US despite existing screening mandates.
• First-trimester screening alone is insufficient, prompting recommendations for repeat screening in the third trimester and at delivery.
• Evidence on the effectiveness of expanded prenatal syphilis screening mandates is limited.

Purpose of the Study:

• To evaluate the effectiveness of expanded prenatal syphilis screening mandates on syphilis case detection during pregnancy.
• To assess the impact of third-trimester and delivery screening mandates on maternal syphilis case detection.

Main Methods:

• A staggered difference-in-differences analysis of birth certificate data from 33 US states (2012-2022).
• Compared maternal syphilis case detection in 4 states with new third-trimester/delivery screening mandates against 29 control states.
• Analyzed inpatient discharge records from Georgia to assess changes in screening coverage.

Main Results:

• Expanded screening mandates were associated with a 26% increase in maternal syphilis case detection in the first quarter post-enactment.
• This increase attenuated over time, with no significant association found within one year (11% increase).
• The study included 16.3 million births and over 20,000 syphilis cases.

Conclusions:

• Expanded prenatal syphilis screening mandates show a short-term benefit in detecting maternal syphilis cases.
• Sustained impact necessitates complementary strategies focusing on clinician adherence and patient treatment access.
• Further research is needed to optimize screening protocols and ensure effective treatment completion.