Syphilis screening in pregnancy.

Consistent with federal guidelines and professional organizations' recommendations, Florida requires that women be screened for syphilis twice during pregnancy and then at delivery. Prenatal screening and, if necessary, treatment with penicillin can prevent congenital syphilis and its serious health effects. Yet in a Florida county where syphilis rates are high, not all women are adequately screened. (1) In a sample of 1,991 women who gave birth in 2001, 83% had had one prenatal screening, 11% had had two, and 9% had been screened twice during pregnancy and then at delivery. In multivariate analyses, the odds of having had no prenatal screening were elevated among blacks and Haitians, women with at most a high school education, those who saw a private provider and those with a public source of insurance. The likelihood of not having had two prenatal screenings was elevated for women who had had more than adequate prenatal care (as measured on a standard index), clients of private clinics and women covered by private insurance. Focusing on the latter set of findings, the analysts suggest that the inadequacy of screening may be due to providers' unawareness of the county's syphilis problem or of screening recommendations and requirements. The authors of an editorial accompanying the study add that providers' noncompliance may be a factor, and stress the need for "enhanced, coordinated efforts by providers and public health professionals to prevent [congenital syphilis]." (2)

(1.) Trepka MJ et al., Inadequate syphilis screening among women with prenatal care in a community with a high syphilis incidence, Sexually Transmitted Diseases, 2006, 33(11):670-674.

(2.) Behrami J and Berman S, Congenital syphilis: a persisting sentinel public health event, Sexually Transmitted Diseases, 2006, 33(11):675-676.

FYI is compiled and written by Dore Hollander, executive editor of Perspectives on Sexual and Reproductive Health.