Study Shows Syphilis Is Increasing Among Pregnant Women

Syphilis is a sexually transmitted infection that has increased significantly among pregnant women and newborns. Mother-to-child transmission during pregnancy can also cause the spread of syphilis. Pharmacists can play an important role in counseling pregnant women on prevention and treatment strategies for syphilis as part of an interdisciplinary team.

A recently published study investigated syphilis trends among pregnant women and examined high-risk behaviors.¹ Syphilis trends were examined from all 50 states and the District of Columbia through the National Notifiable Diseases Surveillance System from 2012-2016.¹ Additionally, risk behavior information was collected through case interviews during routine public health department investigations of syphilis cases.

The study found that the number of syphilis cases among pregnant women increased 61%, from 1,561 to 2,508.¹ Also, 49% of pregnant women with syphilis did not report any high-risk sexual behaviors in the past year.¹ Among the 51% who did report high-risk sexual behaviors, he most commonly reported were a history of a sexually transmitted disease (43%), and more than one sexual partner in the past year (30%).¹ It is concerning that the study revealed the proportion of early syphilis cases increased, since these are more recent infections and have a higher risk of mother-to-child transmission. One limitation of examining case-based surveillance data is that there may be underreporting of syphilis cases leading to an underestimate of the results.¹

The study also demonstrates the importance of routinely screening pregnant women at the first prenatal visit and at the beginning of the third trimester and delivery if at high-risk.^1,2 However, the study demonstrates that almost half of the pregnant women with syphilis did not report any high-risk sexual behavior.¹ Therefore, it may be prudent to screen all pregnant women in their third trimester to prevent congenital syphilis, which occurs during mother-to-child transmission.³ Syphilis transmission can occur during any pregnancy trimester. Over 900 cases of congenital syphilis were reported in 2017, and this has caused deaths and severe health complications (e.g. prematurity, low birth weight, deformities, blindness) in newborns.³

Pharmacists counseling pregnant patients can discuss syphilis prevention strategies, which include correct and consistent use of latex condoms.² Condoms should be stored in a cool, dry place, and they should have no tears or defects. Make sure patients know not to reuse condoms, and they should not be expired.

Counseling can also educate patients that a long-term monogamous relationship with a partner that has been tested for syphilis and is not infected is extremely important. Additionally, pharmacists should ensure that patients are following up with their obstetrician-gynecologist for screenings and regular visits.

Pregnant patients diagnosed with syphilis should be treated with benzathine penicillin G immediately.² Treatment at least 30 days prior to delivery is likely to prevent most cases of congenital syphilis.²

References

• Trivedi S, Williams C, Torrone E, Kidd S. National trends and reported risk factors among pregnant women with syphilis in the United States, 2012-2016. Obstet Gynecol. 2019;133(1):27-32. doi: 10.1097/AOG.0000000000003000.
• Syphilis pocket guide for providers. CDC website. https://www.cdc.gov/std/syphilis/Syphilis-Pocket-Guide-FINAL-508.pdf. Published November 30, 2017. Accessed January 23, 2019.
• Reported STDs in the United States, 2017. CDC website. https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/STD-Trends-508.pdf. Published September 25, 2018. Accessed January 23, 2019.