WHO has released Comprehensive, evidence-based Guidelines which outlines Treponema pallidum (syphilis) screening in pregnant women, emphasizing early diagnosis to prevent devastating fetal outcomes.
This is important because Identification of asymptomatic infections in pregnant women followed by timely treatment can help prevent transmission, adverse pregnancy outcomes, and congenital syphilis. Moreover, untreated syphilis during pregnancy is associated with stillbirth, neonatal death, bone deformities, and neurologic impairment.
In USA syphilis cases have increased overall by 17.6% since 2015; female congenital cases are likewise increasing, with a 7-fold increase in female syphilis cases in California since 2012; rates of congenital syphilis have increased 30% in the past 2 years, and stillbirths ~3-fold since 2016. Therefore clinicians should consult WHO and CDC guidelines for treatment recommendations.
- 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.
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