Antenatal syphilis screening
Untreated syphilis during pregnancy can lead to serious complications, including spontaneous miscarriage, preterm birth, stillbirth or congenital syphilisAustralian Living Evidence Collaboration, 2024Borg, 2023Communicable Diseases Network Australia (CDNA), 2018Eppes, 2022NSW Government, 2023Ong, 2023Rac, 2017. Antenatal syphilis screening using serological testing detects syphilis during pregnancy to ensure prompt treatment and prevention of adverse outcomes.
Because of a resurgence of syphilis in Australia and difficulties in the implementation of accurate risk-based testing, the Communicable Diseases Network Australia (CDNA) National Guidelines for Public Health Units – Syphilis recommend routine antenatal syphilis screening a minimum of 3 times during each pregnancy: at the first antenatal visit, at 26 to 28 weeks and at 36 weeks or birth (whichever is earlier).
However, the frequency of antenatal syphilis screening varies across Australia. Some jurisdictions routinely screen twice: at the first antenatal visit and at 26 to 28 weeks, with the decision to repeat antenatal syphilis screening based on risk-assessment of self-reported social and sexual history of the birthing parent (eg mother), as well as local prevalence and local guidelinesNSW Health Syphilis in Pregnancy and Newborns 2023. People at increased risk of infection include those1Australian Living Evidence Collaboration, 2024Australian Society for Infectious Diseases (ASID), 2022NSW Government, 2023Stafford, 2024Workowski, 2021:
- with a previous syphilis diagnosis
- with partners with syphilis
- with partners who are at increased risk of contracting syphilis (eg bisexual, other men who have sex with men, and transgender women)
- who have been diagnosed with a sexually transmissible infection (STI) within the last 12 months
- with new sexual partners during pregnancy
- with late, limited or no antenatal care
- residing in an area of high prevalence.
Repeat screening based solely on self-reported individual risk factors may miss a significant portion of patients infected with syphilis during pregnancy because risk factors can change, warranting reassessmentStafford, 2024Trivedi, 2019Wu, 2021. Consult local public health units for advice.
Irrespective of the antenatal syphilis screening approach taken, additional screening may be required for people residing in areas with a high prevalence of syphilis; consult local public health units for advice.
Test the birthing parent for syphilis at any time during pregnancy or at delivery if not tested previously.