From the Guidelines
All pregnant women should be screened for syphilis with serologic testing at the first prenatal visit.
Prenatal Syphilis Testing Protocol
The protocol for prenatal syphilis testing involves:
- Initial screening: All pregnant women should be screened for syphilis with serologic testing at the first prenatal visit 1.
- High-risk patients: Pregnant women who are considered at high risk for acquiring syphilis should also be tested at the beginning of the third trimester and at the time of delivery 1.
- Testing methods: The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend using a nontreponemal screening test (RPR or VDRL) initially, followed by a confirmatory treponemal antibody test 1.
- Repeat testing: The CDC recommends repeat screening at 28 weeks and at the time of delivery for pregnant women who are at high risk, live in areas with a high prevalence of syphilis, have not been previously tested, or have had a positive serologic test result for syphilis during the first trimester 1.
From the Research
Prenatal Syphilis Testing Protocol
The protocol for prenatal syphilis (Treponema pallidum) testing involves several steps and considerations, including:
- Screening for syphilis at the first prenatal visit using serological tests 2
- Utilizing rapid diagnostic tests (RDTs) such as Determine™ and SD BioLine Syphilis 3.0, which have high sensitivity and specificity 3
- Considering the use of point-of-care tests (POCTs) like treponemal POCT, which can increase testing and treatment rates and prevent adverse pregnancy outcomes 4
- Using a dual screen and confirm rapid test, although this may not reduce overtreatment of syphilis in pregnant women living in non-venereal treponematoses endemic regions 5
Testing Methods
Different testing methods are available, including:
- VDRL (Venereal Disease Research Laboratory) test and RPR (Rapid Plasma Reagin) test for screening 2
- FTA (Fluorescent Treponemal Antibody) and TPHA (Treponema Pallidum Hemagglutination) tests for confirmation 2
- Determine™ and SD BioLine Syphilis 3.0, which are immunochromatographic tests with high sensitivity and specificity 3
- Dual Path Platform (DPP) Screen and Confirm Assay, which detects both treponemal and non-treponemal antibodies 5
Importance of Early Detection and Treatment
Early detection and treatment of syphilis in pregnancy are crucial to prevent maternofetal complications, as highlighted in a case report of a pregnant woman with latent syphilis 6 Regular antenatal screening and prompt treatment can reduce the risk of congenital syphilis and adverse pregnancy outcomes 4, 6