A local case study published in a recent issue of the New England Journal of Medicine has reinforced the importance of universal and frequent syphilis testing in pregnancy.
Co-authored by King Edward Memorial Hospital neonatologists Dr Simone Schüller and Professor Tobias Strunk, the article chronicled the complications a newborn delivered by caesarean section at 31 weeks, which included multi-organ dysfunction and infection of the central nervous system (neurosyphilis).
“Significantly, the infant’s 29-year-old mother had shown no symptoms of ill health either during her pregnancy or on the birth of her son,” Dr Schüller said.
“Although she had been engaged with antenatal care, she had not been screened for syphilis, contrary to WA recommendations at the time. It was only after the baby underwent a series of medical investigations due to his poor condition that he and his mother were diagnosed with the highly contagious bacterial infection.”
In 2021, Western Australia responded to increasing rates of syphilis across the State – including congenital syphilis – by increasing the frequency of universal syphilis testing in pregnancy.
The recommended regimen changed from a single syphilis screen through pregnancy to at least three screens – at first contact, 28 and 36 weeks or birth. In high-risk (regional) areas, at least five tests during pregnancy are recommended – four tests in pregnancy and one postpartum.
“Congenital syphilis is a preventable disease, and treatment during pregnancy is safe and effective,’ Dr Schüller said.
“We must do everything we possibly can to spare these babies and their mothers from its devastating impacts. Universal testing through pregnancy is the only way to make sure we detect infection in asymptomatic mothers and minimise potential delays in starting treatment.”
Dr Schüller and her team are urging fellow clinicians to take time to explain to patients the need for testing during pregnancy and, in cases where a diagnosis was made, the importance of follow-up care and contact tracing to prevent reinfection and further spread.
The article was published as the US Food and Drug Administration authorised the first at-home over-the-counter test for the STI last week.
The test, from the biotech company NOWDiagnostics, will take 15 minutes and a single drop of blood to determine whether a patient has syphilis – though people are still advised to go to a doctor for further testing to confirm the diagnosis.
The company said the test will be available in the second half of 2024 and is expected to cost US $29.98.
Dr Michelle Tarver, from the FDA, said that access to home tests might help increase initial screening for syphilis
The US, as in Australia, has experienced an escalation in the number of people testing positive with syphilis. Cases increased 80% between 2018 and 2022, when there were more than 207,000 total syphilis cases reported – the highest number since the 1950s, according to the CDC.
The WA Statewide Maternity Share Care Guidelines currently state that additional syphilis screening should be offered to pregnant/ birthing women living in areas impacted by an ongoing syphilis outbreak, including the Perth metropolitan area, the Goldfields, Kimberley and Pilbara, and at-risk areas in the Midwest.
They also recommend that GPs working in regional areas should consider the option of transferring women with an early diagnosis of syphilis to KEMH for treatment.
The enhanced syphilis screening indicators for pregnant women include:
- Positive sexually transmitted infection (STI) in 12 months prior to pregnancy
- Positive STI during this pregnancy
- Infectious syphilis in a previous pregnancy
- One or more new sexual contacts after first syphilis blood test
- Sexual contact who is from a high-risk country
- Sexual contact with a man who has sex with men
- Has unstable accommodation or is experiencing homelessness
- Engages in IVDU during pregnancy.