USPSTF Reaffirms Strong Recommendation for Universal Syphilis Screening During Pregnancy

 USPSTF Reaffirms Strong Recommendation for Universal Syphilis Screening During Pregnancy

The U.S. Preventive Services Task Force (USPSTF) has firmly re-endorsed its 2018 guideline advocating for early and universal syphilis screening among pregnant adolescents and adults. According to the Task Force, there is a “substantial net benefit” to screening, enabling prompt, evidence-based evaluation and treatment. This recommendation carries the highest grade of “A” with “high certainty.” If screening is missed early in pregnancy, the USPSTF advises it be conducted at the earliest possible opportunity.

Importance of Syphilis Screening in Pregnancy

Published on May 13, 2025, in JAMA, the updated recommendation highlights the serious risks untreated syphilis poses to the fetus. Congenital syphilis, transmitted from mother to child during pregnancy, can cause a range of severe complications such as low birth weight, premature delivery, stillbirth, neonatal death, and significant infant deformities including bone malformations, anemia, enlarged liver and spleen, jaundice, and neurological issues.

The reaffirmation follows the alarming rise in congenital syphilis cases, with 3,882 cases reported across the United States in 2023, including 279 related stillbirths and infant deaths—the highest toll in over three decades. This surge prompted the USPSTF to review the latest evidence to weigh the benefits and potential harms of screening during pregnancy.

“The incidence of syphilis cases has steadily increased over the past 30 years, with women experiencing a 2 to 4 times higher rise compared to men between 2017 and 2021,” the authors note, emphasizing the urgency of screening efforts.

According to a 2023 CDC report, timely testing and treatment could have prevented nearly 90% of congenital syphilis cases.

Screening Benefits and Potential Harms

The USPSTF found no new evidence that challenges previous findings supporting the benefits of syphilis screening during pregnancy. No new studies specifically assessing screening effectiveness for reducing congenital syphilis or improving maternal outcomes were identified.

Past research shows that pregnant women who undergo syphilis screening and receive treatment experience significantly fewer adverse pregnancy outcomes. Earlier treatment is especially crucial; a 2014 review of 54 studies demonstrated that treatment initiated before the third trimester greatly lowers the risk of congenital syphilis, preterm birth, low birth weight, stillbirth, and neonatal death. Delayed treatment results in smaller reductions in these risks.

The updated review assessed data from five studies involving over 51,000 participants on screening harms and two smaller studies on treatment harms. In one small study, 5.1% of patients receiving penicillin experienced Jarisch-Herxheimer reactions—a transient inflammatory response. Another study explored protocols for penicillin desensitization in pregnant women with penicillin allergies, finding that oral desensitization triggered reactions in 27.3% of high-risk patients, while intravenous desensitization resulted in reactions in 2.5%. These findings align with previously known treatment risks.

Conclusion

After reviewing current evidence, the USPSTF strongly endorses early, universal syphilis screening during pregnancy, reaffirming its 2018 position. No new data warranted altering the recommendation.

“The USPSTF found no substantial new evidence that would change the grade of its recommendation,” the authors concluded, reinforcing the critical role of screening in protecting maternal and infant health.

Public Health Implications and Next Steps

The continued rise in syphilis cases among pregnant women underscores the need for robust public health strategies to improve screening rates and access to treatment. Healthcare providers are encouraged to integrate syphilis testing as a standard component of prenatal care and to educate patients on the importance of early screening.

Moreover, enhanced outreach and education programs targeting populations at higher risk—including adolescents and women in underserved communities—are essential to curb the spread of syphilis and reduce congenital infections. Early diagnosis and treatment not only improve health outcomes for mothers and infants but also help prevent long-term healthcare costs associated with congenital syphilis complications.

Addressing Barriers to Screening and Treatment

While the benefits of syphilis screening are well-established, barriers such as limited access to prenatal care, lack of awareness, and concerns about treatment side effects can hinder timely diagnosis and intervention. The USPSTF recommends that healthcare systems work to remove these obstacles by expanding testing availability, offering culturally sensitive counseling, and ensuring pregnant individuals receive appropriate follow-up care.

In cases of penicillin allergy, careful evaluation and desensitization protocols are advised to safely administer the necessary treatment, as penicillin remains the most effective therapy for syphilis during pregnancy.

Syphilis and Maternal Health

Syphilis is a preventable and treatable infection, but when left unchecked, it poses serious risks to maternal and neonatal health. The reaffirmation of universal screening by the USPSTF highlights the importance of consistent vigilance and proactive measures in prenatal care settings.

Beyond screening, comprehensive sexual health education and regular testing for sexually transmitted infections (STIs) remain key components of reducing syphilis incidence overall. Integration of syphilis screening with other STI tests can streamline care and maximize prevention efforts.

Final Remarks

The USPSTF’s reaffirmed recommendation represents a critical step in combating the resurgence of syphilis among pregnant women and protecting future generations from congenital syphilis. By prioritizing early and universal screening, healthcare providers can identify infections promptly and ensure effective treatment, substantially improving outcomes for both mothers and babies.

Practical Guidance for Clinicians

Healthcare providers should prioritize syphilis screening at the first prenatal visit for all pregnant individuals, regardless of perceived risk. For those who miss early screening, testing should occur as soon as possible afterward. In areas or populations with higher syphilis prevalence, repeat screening later in pregnancy may be warranted to catch any new infections.

Clinicians must remain vigilant for signs of syphilis infection and provide counseling about the importance of treatment adherence. Penicillin remains the treatment of choice, and in cases of allergy, referral for desensitization protocols is essential to ensure safe and effective therapy.

In addition, documenting and reporting cases to public health authorities helps track trends and supports targeted interventions to reduce transmission.

Areas for Future Research

While the current evidence strongly supports screening, ongoing research is needed to optimize screening strategies, especially in diverse populations. Studies that evaluate the cost-effectiveness of repeat screening in late pregnancy, novel diagnostic technologies, and patient-centered approaches to improving screening uptake could enhance prevention efforts.

Research into alternative treatments for those unable to receive penicillin and investigations into the social determinants driving rising syphilis rates will also be critical for comprehensive disease control.

Closing Thoughts

The USPSTF’s reaffirmation underscores the vital role of universal syphilis screening during pregnancy as a life-saving public health measure. Early identification and treatment not only prevent devastating outcomes but also contribute to controlling the broader syphilis epidemic.

Pregnant individuals and healthcare providers alike should remain informed about the risks of syphilis and the benefits of screening to ensure healthy pregnancies and healthy babie 

Stakeholder Perspectives

Public Health Officials emphasize that rising syphilis rates—especially among women of reproductive age—signal a need for urgent, coordinated responses. Local health departments are encouraged to work closely with healthcare systems to ensure screening is not only recommended but consistently implemented, particularly in regions with limited access to prenatal care.

Obstetricians and Midwives play a central role in prevention efforts, as they are often the first point of contact for pregnant individuals. Integrating syphilis testing into standard prenatal protocols and reinforcing follow-up care are critical actions that frontline providers can take immediately.

Community Organizations and Advocacy Groups are also key allies in the fight against congenital syphilis. By raising awareness, combating stigma, and helping pregnant individuals access prenatal services, these groups help fill gaps where traditional healthcare systems may fall short.

Policy and Funding Implications

The reaffirmation of universal screening may serve as a catalyst for expanding federal, state, and local funding to support syphilis prevention and maternal health programs. Increased investment in:

• Access to early prenatal care

• Provider training on STI management

• Laboratory testing infrastructure

• Treatment availability, especially in underserved communities

...can ensure that the USPSTF’s recommendations are not just guidelines but actionable standards applied across the country.

Additionally, policies mandating syphilis screening during pregnancy—already in place in many states—may be strengthened or better enforced in response to this reaffirmation.

Syphilis Screening as a Model for Preventive Care

This recommendation also reinforces a broader principle in medicine: preventive care saves lives. Syphilis screening in pregnancy is a clear example of how early detection and timely intervention can prevent tragic outcomes. It also serves as a model for the importance of consistent guidelines, routine implementation, and follow-up across the entire healthcare continuum.

Final Conclusion

As syphilis rates continue to rise and congenital syphilis reaches historic highs, the U.S. Preventive Services Task Force’s renewed call for universal screening during pregnancy is both timely and essential. The benefits of screening are unequivocal—early detection and treatment drastically reduce the risk of severe complications and deaths in newborns.

Through collaboration among healthcare providers, public health agencies, policymakers, and communities, the goal of eliminating congenital syphilis is within reach. The path forward begins with a simple but powerful action: screening every pregnant person for syphilis—early, universally, and without exception.

The Role of Education and Awareness

Raising awareness among both healthcare providers and the public is essential in achieving widespread implementation of syphilis screening in pregnancy. Many pregnant individuals may be unaware of the risks syphilis poses or may not perceive themselves to be at risk.

Educational campaigns—whether through prenatal clinics, community health workers, or digital outreach—can play a vital role in increasing acceptance of testing. Materials should be culturally appropriate, translated into multiple languages, and tailored to reach vulnerable or marginalized populations.

Healthcare providers should also receive ongoing training on syphilis testing guidelines, clinical symptoms that may otherwise go unnoticed, and best practices for patient counseling and follow-up care. Knowledge gaps among providers can lead to missed opportunities for diagnosis and treatment.

Addressing Health Equity

Equity remains a major consideration in the fight against congenital syphilis. The burden of the disease disproportionately affects communities with limited access to prenatal care—often due to socioeconomic barriers, lack of insurance, immigration status, or geographic isolation.

To ensure that no pregnant person is left behind, screening initiatives must be integrated with broader efforts to improve maternal healthcare access. This includes:

• Strengthening rural and underserved healthcare systems

• Expanding Medicaid and public health insurance coverage for prenatal care

• Funding mobile clinics and telehealth services for remote populations

• Reducing stigma surrounding STI testing through community engagement

By approaching syphilis screening through an equity lens, the healthcare system can more effectively serve those most at risk.

A Global Health Perspective

While this recommendation is focused on the United States, congenital syphilis remains a global public health challenge, especially in low- and middle-income countries where access to routine prenatal care may be limited. The World Health Organization (WHO) has identified the elimination of mother-to-child transmission of syphilis as a key international priority.

Lessons from the U.S. reaffirmation can inform global strategies—underscoring the importance of:

• Integrating syphilis screening with existing maternal and child health services

• Ensuring availability of diagnostic tools and medications

• Training healthcare workers in low-resource settings

• Tracking data to identify outbreaks and target interventions

Collaborative efforts between nations, NGOs, and international health agencies will be vital to achieving global reduction goals.

A Call to Action

This reaffirmation by the USPSTF is not just a clinical guideline—it is a call to action. Every missed screening is a missed opportunity to prevent avoidable suffering. Every case of congenital syphilis is a sign that the system failed to intervene when it could have.

Healthcare professionals, policy makers, and communities must work together to ensure that screening is:

• Standardized in every prenatal care visit

• Accessible to all, regardless of income, location, or background

• Supported by policies, education, and funding that prioritize maternal and infant health

By reinforcing early and universal screening for syphilis during pregnancy, the medical community can take a powerful step toward a future free from congenital syphilis—a future where every baby has a healthier start to life.

                           Dr. Ifrah Hassan Hilaac