Prevention Recommendations
Screening: All pregnant patients should receive comprehensive screening for STIs, including syphilis and HIV, at their first prenatal visit. For women (or other persons) who are at higher risk for syphilis acquisition during pregnancy, or whose risk status is unclear, serologic testing should also be performed twice during the third trimester: at 28-32 weeks’ gestation and at delivery.
Pregnant women at higher risk of syphilis infection during pregnancy include:
✓ Pregnant women who live in communities with high rates of syphilis.
✓ Women who have new sex partners, multiple sex partners, sex in conjunction with drug use, or transactional sex during their pregnancy.
✓ Women who use drugs, particularly methamphetamine or heroin.
✓ Women who are incarcerated, or whose partners are incarcerated.
✓ Women experiencing unstable housing or who are unhoused.
Any woman who has a fetal death after 20 weeks’ gestation should be tested for syphilis. Any neonate at risk for CS should also receive a full evaluation and testing for HIV. Clinicians who see pregnant women for any reason, including at emergency department visits, should offer comprehensive STD and HIV screening, as this may be the only point of care during pregnancy for some vulnerable populations. Healthcare systems should employ assessments and interventions to increase compliance with screening guidelines among their providers.
No mother or neonate should leave the hospital without maternal serologic status having been documented at least once during pregnancy.
Treatment: Pregnant women diagnosed with syphilis should be treated immediately with an appropriate regimen (please refer to the CDC’s 2021 STI Treatment Guidelines). Pregnant women who receive treatment at least 30-days prior to birth lower the risk of infection in their baby by 98%. Their sex partner(s) should also receive treatment to prevent the mother from becoming re-infected and to improve the health of her partner. Neonates should be screened and treated as needed.
Penicillin G benzathine (Bicillin L-A) is the only recommended treatment for syphilis during pregnancy and for CS; no proven therapeutic alternatives exist. Desensitization is therefore required for pregnant women who have a documented penicillin allergy. Private clinicians without access to Bicillin L-A are encouraged to work with their local health department to identify timely and affordable treatment options for their patients. Recent national shortages of Bicillin L-A further complicate prevention efforts. In the event of penicillin shortages, VDH has compiled resources for patient prioritization and possible alternative therapies.
*Source: https://www.vdh.virginia.gov/content/uploads/sites/110/2024/02/Syphilis-Epi-Report-2013-2022.pdf