USPSTF Continues to Recommend Syphilis Screening Early in Pregnancy

TUESDAY, May 13, 2025 (HealthDay News) — The U.S. Preventive Services Task Force (USPSTF) recommends screening for syphilis during pregnancy. This recommendation forms the basis of a final recommendation statement published online May 13 in the Journal of the American Medical Association.

Gary N. Asher, M.D., M.P.H., from the University of North Carolina at Chapel Hill, and colleagues updated the evidence for the benefits and harms of screening and harms of treatment of syphilis during pregnancy to reaffirm the 2018 USPSTF recommendation. The researchers found that no new studies addressed the effectiveness of screening to reduce congenital syphilis or other adverse pregnancy outcomes. Five new studies, with 51,118 participants, addressed the harms of screening, and two, with 130 participants, addressed the harms of treatment. In terms of harms of screening, index test positivity ranged from 1.0 to 4.8 percent, with estimates of false positives varying from 0 to 65 percent. False-positive rates varied substantially using a reverse-sequence, two-step screening process (7 to 65 percent). In terms of treatment harms, 2.5 percent of participants had adverse reactions to standard penicillin provocation or desensitization protocols.

Based on the reaffirmation evidence update, the USPSTF concludes that screening for syphilis infection in pregnancy has a substantial net benefit. Early, universal screening for syphilis infection is recommended; screening should be conducted at the first available opportunity if an individual is not screened early in pregnancy (A recommendation).

“To reverse the uptrend in congenital syphilis, clinicians providing prenatal care must maintain high fidelity to screening guidelines and take responsibility for overcoming the systematic barriers that impede effective syphilis management,” write the authors of an accompanying editorial.

Evidence Report

Final Recommendation Statement

Editorial