ACOG Recommends Obstetrician-Gynecologists Increase Syphilis Screening for Pregnant Individuals

Washington, D.C.— In the context of the rapidly increasing rates of congenital syphilis across the country, ACOG has issued updated guidance for obstetrician–gynecologists recommending that they now screen pregnant individuals for syphilis three times during pregnancy.

According to the new ACOG Practice Advisory, obstetrician–gynecologists and other obstetric care professionals should screen all pregnant individuals serologically for syphilis at the first prenatal care visit, followed by universal rescreening during the third trimester and again at birth. This is a change from previous guidance, which recommended risk-based testing in the third trimester only for individuals living in communities with high rates of syphilis and for those who have been at risk of syphilis acquisition during pregnancy.

“There has been a near eightfold increase in congenital syphilis cases in the last decade or more, and from a public health perspective, we recognize that obstetrician–gynecologists and other obstetric care clinicians play a critical role,” said Christopher Zahn, MD, FACOG, interim CEO and chief of clinical practice and health equity and quality. “While we continue to endorse CDC’s sexually transmitted infection treatment guidelines, ACOG’s new guidance will no longer follow an individualized risk-based approach to testing later in pregnancy and instead help ensure more opportunities for testing and treatment.”

The updated guidance acknowledges the racial and ethnic inequities that exist in congenital syphilis rates, with neonates birthed by American Indian or Alaska Native, Native Hawaiian or Pacific Islander, and Black or African American individuals accounting for the largest numbers of congenital syphilis cases in 2022. The guidance states that the approach to this public health crisis must involve all individuals working together in the health care space with a focus on cultural awareness, humility, and trust-building.

“Timely diagnosis and treatment are key to reducing syphilis rates, and yet we are currently facing several challenges, including treatment shortages, lack of access to prenatal care, and the stigma that surrounds sexually transmitted infections,” said Dr. Zahn. “Congenital syphilis can have devastating effects. We know that a majority of cases can be prevented, so additional routine screening during pregnancy is one important step that clinicians can take that could potentially be lifesaving.”