Expanded Syphilis Screening Recommendations for the Prevention of Congenital Syphilis
December 15, 2020
In 2018, there were 329 infants with congenital syphilis (CS) reported in California, representing a 900 percent increase from 2012, and a magnitude of CS burden not observed since 1995. These trends mirror a sharp rise in syphilis among females, which surpassed 500 percent during the same period. As a result, the California Department of Public Health (CDPH) has just released new guidelines for expanded syphilis detection among people who are or could become pregnant in order to ensure detection, timely treatment, and subsequent CS prevention.

Orange County had 37 cases of Congenital Syphilis/100,000 live births in 2018 and 2019. Therefore, Orange County is considered a high morbidity county for Congenital Syphilis. 
CDPH Recommendations for Providers:
  • All pregnant patients should be screened for syphilis at least twice during pregnancy: once at either confirmation of pregnancy or at the first prenatal encounter (ideally during the first trimester) – and again during the third trimester (ideally between 28–32 weeks’ gestation), regardless of whether such testing was performed or offered during the first two trimesters.
  • Patients should be screened for syphilis at delivery, except those at low risk who have a documented negative screen in the third trimester.
  • Emergency department (ED) providers in local health jurisdictions with high-CS morbidity should consider confirming the syphilis status of all pregnant patients prior to discharge, either via documented test results in pregnancy, or a syphilis test in the ED if documentation is unavailable.
  • All people who are or could become pregnant entering an adult correctional facility located in a local health jurisdiction with high-CS morbidity should be screened for syphilis at intake, or as close to intake as feasible.
  • All sexually active people who could become pregnant should receive at least one lifetime screen for syphilis, with additional screening for those at increased risk.
  • All sexually active people who could become pregnant should be screened for syphilis at the time of each HIV test. 

A complete guide to these recommendations, Expanded Syphilis Screening Recommendations for the Prevention of Congenital Syphilis, was published by the CDPH Sexually Transmitted Diseases (STD) Control Branch. This guidance includes evidence underlying these recommendations, analysis of related existing state and national policy, as well as considerations for practice implementation.

For patients diagnosed with syphilis, detailed recommendations for treatment and follow-up can be accessed via the 2015 Centers for Disease Control and Prevention (CDC) STD Treatment Guidelines along with CDC STD Treatment Recommendations in the Age of COVID-19.
Contact Information:
Feel free to contact Dr. Christopher Ried, STD Controller of Orange County, if you need assistance in the syphilis screening or care of your patients. He can be reached at (714) 834-8598. 
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