Syphilis screening in pregnant women : WHO Guidelines

• The WHO STI guideline recommends screening all pregnant women for syphilis during the first antenatal care visit.


• CDC recommends that at-risk (with oral, anal, or vaginal-infected sex partner) women are also screened at the start of the third trimester and at delivery.


• WHO recommends that on-site rapid syphilis tests be conducted; if positive, further confirmation by nontreponemal rapid plasma reagin (RPR) test is required.


• In addition to RPR test, dark-field examination can also detect T pallidum directly from lesion exudate or tissue.


• According to CDC, presumptive diagnosis requires nontreponemal and treponemal tests; reverse sequence screening algorithm for syphilis testing is also used.


• In settings with low coverage of syphilis screening and treatment for pregnant women, high loss to follow-up of pregnant women, or limited laboratory capacity, the WHO STI guideline suggests on-site tests (Strategies A, B, and C) rather than the standard off-site laboratory-based screening and treatment strategy


• In settings with a low prevalence of syphilis (below 5%), the WHO STI guideline suggests a single on-site rapid syphilis test (RST) be used to screen pregnant women(Strategy A) rather than a single on-site rapid plasma reagin (RPR) test (Strategy B).


• In settings with a high prevalence of syphilis (5% or greater), the WHO STI guideline suggests an on-site rapid syphilis test (RST) and, if positive, provision of a first dose of treatment and a rapid plasma reagin (RPR) test, and then, if the RPR test is positive, provision of treatment according to duration of syphilis (Strategy C).

In order to ensure effective treatment for all STIs, WHO plans a phased approach to updating the STI guidelines to address a range of infections and issues.