Screening For Syphilis In Pregnancy Research Articles

Prevalence of Syphilis among Pregnant Women attending antenatal care clinic, Udaipur, Southern Rajasthan

Background Maternal syphilis is an important cause of adverse pregnancy outcome . Syphilis, caused by infection with Treponema pallidum, is a mucocutaneous sexually transmitted infection (STI) with high infectivity in the early stages. Untreated maternal syphilis is strongly associated with adverse birth outcomes including increased incidence of stillbirths, low birth weight and premature live births compared with uninfected women. The WHO recommends serological test for syphilis in pregnancy and treatment with injectable penicillin, including the partner, as a routine part of antenatal care. Ideally this screening should be done in the first trimester or at first antenatal visit and again early in the third trimester. Method A retrospective, quantitative study of hospital and laboratory records of all pregnant women booked at the RNT Medical college for antenatal care in a one-year period (1ST JULY 2021 to 30TH JUNE 2022) was carried out. Data were collected from department register maintained by authority. VDRL testing was done to screen the patient. Data were analysed. Result : During the study period, 10194 antenatal clinic patients had VDRL screening out of which 27 were positive. The overall prevalence rate in this study was 0.26% Conclusion Universal screening of all pregnant women at first antenatal visit with a non-treponemal test should be used for screening for syphilis in pregnancy. Also considering prevalence of gestational syphilis in Udaipur region , policy translation is required at state and national level to scale up prevention, screening, and management of syphilis.

Towards the elimination of mother to child transmission of syphilis 2015–2020: practice and progress in Zhejiang province, eastern China

ObjectivesTo estimate the progress towards elimination of mother-to-child transmission (EMTCT) of syphilis in Zhejiang province.MethodsData were obtained from Zhejiang provincial EMTCT network. Childbearing women infected with syphilis during 2015–2020 were recruited. Joinpoint mode was used to analyze changing trends in syphilis screening, treatment and adverse pregnancy outcomes (APOs). Changing trends were presented as the annual percentage of change (APC). Multivariate logistic regression mode was used to analyzerisk factors of APOs.ResultsOf 3,658,266 participants, an average maternal syphilis incidence was 0.38%. From 2015 to 2020, the coverage of syphilis screening in pregnancy (96.31% to 99.24%; P < 0.001) and coverage of antenatal health care (ANC) within 13 gestational weeks (55.27% to 77.82%; P = 0.002) were increased.The coverage of maternal syphilis treatment(88.30% to 98.25%; P = 0.001) and adequate treatment (66.92% to 83.37%; P = 0.001) were also increased. Over the years, the APC was -19.30% (95%CI:-24.33 ~ -13.92, P = 0.001) in perinatal death,-26.55% in congenital syphilis(95%CI:-38.75 ~ -11.92, P = 0.009), and -14.67% in other neonatal complications (95%CI:-23.96 ~ -4.24, P = 0.019).In 2020, 11.58% of women had APOs. The rate of syphilis infection during pregnancy increased among women aged (< 20 years) or (≥ 35 years), multiparous, and with pregnancy complications (all P < 0.05).APOs risk increased in women with higher maternal RPR/TRUST titers while it decreased in women who had (adequate) therapy, early ANC, and aged in 21–34 years (all P < 0.001).ConclusionsDespite steady progress towards the goal of EMTCT in implementing universal screening and treatment, syphilis continuously affects a large number of pregnant women. Increasing vulnerable women, small proportions of inadequately treated and delay in early ANC should be noticed.

Syphilis in pregnancy: The menace continues to haunt

Syphilis in pregnancy remains an important medical condition due to its adverse perinatal consequences and potential to cause congenital syphilis. The cases of congenital syphilis have been reported worldwide as there is increase in cases of syphilis in women. We hereby present a case of 34-year-old multigravida who was diagnosed with syphilis during her first antenatal visit in second trimester and managed. The baby did not show any signs of congenital syphilis. This report highlights the diagnostic workup, management and possible complications of syphilis in pregnancy. Universal screening of all pregnant women at first antenatal visit with a non-treponemal test should be used for screening for syphilis in pregnancy.

A qualitative comparison of society guidelines for syphilis screening in pregnancy

A qualitative comparison of society guidelines from stakeholders who care for pregnant women and/or children potentially affected by syphilis or congenital syphilis was conducted to evaluate for potential modifications and recommendations.

Repeat screening for syphilis in pregnancy as an alternative screening strategy in the UK: a cost-effectiveness analysis

ObjectivesTo assess the cost-effectiveness of universal repeat screening for syphilis in late pregnancy, compared with the current strategy of single screening in early pregnancy with repeat screening offered only to...

Screening for Hepatitis B Infection in Pregnant Women: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

Importance The incidence of syphilis and congenital syphilis in the United States has increased after reaching historic lows in the early 2000s. Objective To systematically review literature on the effectiveness and harms of screening for syphilis in pregnancy and the harms of penicillin treatment in pregnancy to inform the US Preventive Services Task Force. Data Sources MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials for relevant English-language literature, published from January 1, 2008, to June 2, 2017. Ongoing surveillance was conducted through November 22, 2017. Study Selection Studies conducted in countries categorized as “high” or “very high” on the Human Development Index that explicitly addressed 1 of 3 a priori–defined key questions. Data Extraction and Synthesis Independent critical appraisal and data abstraction by 2 reviewers. Data from included studies were narratively synthesized without pooling data. Main Outcomes and Measures Incidence of congenital syphilis; any harms of screening or penicillin treatment in pregnancy. Results Seven studies in 8 publications were included. One observational study evaluated the implementation of syphilis screening in pregnancy in 2 441 237 women in China. From 2002 to 2012, screening for syphilis in all pregnant women increased from 89.8% to 97.2%, and the incidence of congenital syphilis decreased from 109.3 to 9.4 cases per 100 000 live births. Five studies (n = 21 795) evaluated the false-positive findings of treponemal tests and 1 study (n = 318) evaluated the false-negative findings of nontreponemal tests. These studies found that false-positives with treponemal-specific enzyme or chemiluminescent immunoassays were common (46.5%-88.2%), therefore warranting reflexive (automatic confirmatory) testing for all positive test findings. One study (n = 318) found no false-negatives with treponemal tests, and 1 study (n = 139) demonstrated the prozone phenomenon (false-negative response from high antibody titer) with rapid plasma reagin screening using undiluted samples (2.9%). No studies were identified for harms of penicillin in pregnancy. Conclusions and Relevance Screening for syphilis infection in pregnant women is associated with reduced incidence of congenital syphilis, and available evidence supports the need for reflexive testing for positive test results.

Syphilis screening and treatment in pregnant women in Kinshasa, Democratic Republic of the Congo and in Lusaka, Zambia: a cross-sectional study

Background: Congenital syphilis is associated with perinatal deaths, preterm births and congenital malformations. Low rates of syphilis screening during pregnancy and treatment of those found seropositive have been reported in the Democratic Republic of the Congo (DRC) and Zambia. We report the rates on antenatal syphilis screening, the seroprevalence of syphilis infection, and the frequency of antibiotic treatment in pregnant women screened positive for syphilis during their attendance at antenatal care (ANC) clinics in Kinshasa, DRC and Lusaka, Zambia. Methods: Women attending their first ANC were enrolled consecutively during a 9-month period in 16 and 13 ANC clinics in Kinshasa and Lusaka respectively, in the context of the baseline period of a cluster trial. Study personnel collected data on women’s characteristics, the syphilis screening practices, the test results, and the frequency of treatment, that were done under routine ANC conditions and registered in the clinic records. Results: 4,153 women in Kinshasa and 18,097 women in Lusaka were enrolled. The frequency of screening at the first visit was 59.7% (n= 2,479) in Kinshasa, and 27.8% (n=5,025) in Lusaka. Screening test availability varied. In the periods in which tests were available the screening rates were 92.8% in Kinshasa and 52.0% in Lusaka. The frequency of women screened seropositive was 0.4% (n=10) in Kinshasa and 2.2% (n=109) in Lusaka. Respectively, 10% (n=1) and 11.9% (n= 13) among seropositive women received treatment at the first visit. Conclusions: The results of the study show that screening for syphilis in pregnancy is not universal even when supplies are available. Our ongoing trial will evaluate the impact of a behavioral intervention on changing health providers’ practices to increase screening and treatment rates when supplies are available.

Syphilis screening and treatment in pregnant women in Kinshasa, Democratic Republic of the Congo and in Lusaka, Zambia: a cross-sectional study.

Background: Congenital syphilis is associated with perinatal deaths, preterm births and congenital malformations. Low rates of syphilis screening during pregnancy and treatment of those found seropositive have been reported in the Democratic Republic of the Congo (DRC) and Zambia. We report the rates on antenatal syphilis screening, the seroprevalence of syphilis infection, and the frequency of antibiotic treatment in pregnant women screened positive for syphilis during their attendance at antenatal care (ANC) clinics in Kinshasa, DRC and Lusaka, Zambia. Methods: Women attending their first ANC were enrolled consecutively during a 9-month period in 16 and 13 ANC clinics in Kinshasa and Lusaka respectively, in the context of the baseline period of a cluster trial. Study personnel collected data on women's characteristics, the syphilis screening practices, the test results, and the frequency of treatment, that were done under routine ANC conditions and registered in the clinic records. Results 4,153 women in Kinshasa and 18,097 women in Lusaka were enrolled. The frequency of screening at the first visit was 59.7% (n= 2,479) in Kinshasa, and 27.8% (n=5,025) in Lusaka. Screening test availability varied. In the periods in which tests were available the screening rates were 92.8% in Kinshasa and 52.0% in Lusaka. The frequency of women screened seropositive was 0.4% (n=10) in Kinshasa and 2.2% (n=109) in Lusaka. Respectively, 10% (n=1) and 11.9% (n= 13) among seropositive women received treatment at the first visit. Conclusions: The results of the study show that screening for syphilis in pregnancy is not universal even when supplies are available. Our ongoing trial will evaluate the impact of a behavioral intervention on changing health providers' practices to increase screening and treatment rates when supplies are available.

Syphilis screening in pregnancy in the United Kingdom, 2010-2011: a national surveillance study.

To evaluate the national antenatal syphilis screening programme and provide evidence for improving screening and management strategies. National population-based surveillance. United Kingdom (UK). All pregnant women screening positive for syphilis, 2010-2011. Demographic, laboratory and treatment details for each pregnancy were collected from UK antenatal units (~210), along with follow-up information on all infants born to women requiring syphilis treatment in pregnancy. Proportion of women with newly or previously diagnosed syphilis among those with positive screening tests in pregnancy; proportion requiring treatment. Overall, 77% (1425/1840) of reported pregnancies were confirmed syphilis screen-positive. Of these, 71% (1010/1425) were in women with previously diagnosed syphilis (155 requiring treatment), 26% (374/1425) with newly diagnosed syphilis (all requiring treatment) and 3% (41/1425) required treatment but the reason for treatment was unclear. Thus 40% (570/1425) required treatment overall; of these, 96% (516/537) were treated (missing data: 33/570), although for 18% (83/456), this was not until the third trimester (missing data: 60/537). Follow up of infants born to treated women was poor, with at least a third not followed. Six infants were diagnosed with congenital syphilis; two mothers were untreated, three had delayed treatment and one had incomplete treatment (first trimester). Over 2years, among pregnant women with confirmed positive syphilis screening results in the UK, a quarter had newly diagnosed infections and 40% required treatment. Despite high uptake of treatment, antenatal syphilis management could be improved by earlier detection, earlier treatment, and stronger links between healthcare teams. 25% of pregnant women screening positive for syphilis in the UK were newly diagnosed and 40% needed treatment.

Gestational and Congenital Syphilis Epidemic in the Colombian Pacific Coast

Congenital syphilis (CS) is a major global public health problem. Buenaventura, a socioeconomically deprived municipality in the Colombian Pacific Coast, accounts for 6.6% of all CS cases in Colombia. To begin to understand the main reasons for the high rates of the disease in Buenaventura, we conducted a retrospective electronic health record analysis of all infants admitted with CS during the first 7 months of 2011 to the Hospital Departamental de Buenaventura, the city's main birthing hospital. The diagnosis of gestational syphilis and CS was based on a predefined Colombian public health service algorithm. Clinical, laboratory, and sociodemographic parameters for all infants studied, including maternal access to prenatal care, syphilis serologic diagnosis, and adequacy of penicillin treatment, were abstracted and analyzed. A total of 89 infants met the case definition for CS. Most mothers (80%) were affiliated with government-regulated or private health care insurance plans. While 64 (70%) of 92 attended at least 1 antenatal care visit and 59 of these 64 (84%) were screened for syphilis, only 5 (8%) of 59 received appropriate antibiotic therapy. Although most infants were asymptomatic at birth, prematurity (15/82) was common. Two infants died in the neonatal period, and 5 pregnancies ended in stillbirth. Our findings confirm that Buenaventura has a very high incidence of CS and demonstrate that existing antenatal care gestational syphilis programs are flawed. Prevention strategies should emphasize enhanced early syphilis screening in pregnancy, preferably through the implementation of point-of-care testing in the community and same-day treatment with at least 1 dose of penicillin.

P3.353 Congenital Syphilis in Buenaventura, Colombia: Description of a Case Series in a Neglected Pacific Coast Town

BackgroundSyphilis in pregnant women is a world-wide health problem leading to serious adverse outcomes. Although there are strategies to prevent congenital syphilis (CS) through antenatal screening, disease burden still remains...

Syphilis: still a major cause of infant mortality

We read with interest Sarah Hawkes and colleagues' Article1 that assessed the effectiveness of interventions to improve screening for syphilis in pregnancy. The investigators highlight several possible interventions during pregnancy and suggest that antenatal syphilis screening could reduce the incidence of perinatal death and stillbirths attributable to syphilis by 50%. In addition to the interventions during pregnancy, we would like to draw attention to the importance of premarital syphilis screening for prevention of adverse syphilis-related pregnancy outcomes in syphilis-epidemic countries such as China.

Syphilis: still a major cause of infant mortality

www.thelancet.com/infection Vol 12 April 2012 269 1 Mabey D, Peeling RW. Syphilis, still a major cause of infant mortality. Lancet Infect Dis 2011; 11: 654–55. 2 Hawkes S, Matin N, Broutet N, Low N. Eff ectiveness of interventions to improve screening for syphilis in pregnancy: a systematic review and meta-analysis. Lancet Infect Dis 2011; 11: 684–91. 3 Walker DG, Walker GJ. Forgotten but not gone: the continuing scourge of congenital syphilis. Lancet Infect Dis 2002; 2: 432–36. 4 Walker GJA. Antibiotics for syphilis diagnosed during pregnancy. Cochrane Database Syst Rev 2001; 3: CD001143. 5 Blencowe H, Cousens S, Kamb M, Berman S, Lawn JE. Lives saved tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality. BMC Public Health 2011; 11 (suppl 3): S9. 6 Walker DG, Walker GJA. Prevention of congenital syphilis—time for action. Bull World Health Organ 2004; 82: 401. 7 Walker GJA, Walker DG. Congenital syphilis: a continuing but neglected problem. Semin Fetal Neonatal Med 2007; 12: 198–206. makers might have chosen to give little attention to the scourge of congenital syphilis in part because of two Cochrane systematic reviews, which they incorrectly claimed showed “no good evidence that the treatment of syphilis in pregnant women improved pregnancy outcome”. However, the systematic review, authored by one of us, concluded that “...there is no doubt that penicillin is eff ective in the treatment of syphilis in pregnancy and the prevention of congenital syphilis”. The second review mentioned by Mabey and Peeling states that “detection and appropriate, timely penicillin treatment is a highly eff ective intervention to reduce adverse syphilis-related pregnancy outcomes”. To misinterpret the fi ndings of systematic reviews and place responsibility on them for the failure to adequately control congenital syphilis diverts attention away from organisations such as WHO, which should be working with governments and other partners to increase eff orts to tackle congenital syphilis. Unfortunately, babies in countries as diverse as Australia, Belarus, China, and Haiti continue to be born with congenital syphilis. This situation should be unacceptable. That antenatal screening and treatment can work is well known, and yet there has been limited success over the past decade in controlling, let alone eliminating, congenital syphilis. As we have argued previously on several occasions, the time has come to be more ambitious, resourceful, and innovative in preventing this tragedy. Business as usual is not an option.

Congenital syphilis in Switzerland: gone, forgotten, on the return.

Acquired syphilis has re-emerged in many Western European countries. In contrast to international guidelines, screening for syphilis in pregnancy is not generally recommended in Switzerland. There has been an increase in the incidence of laboratory syphilis notifications in recent years, regardless of gender and age. We conducted a retrospective study, evaluating the total numbers of pregnant women with positive syphilis serology (Treponema pallidum Particle Agglutination assay, TPPA) from 2000 to 2009, and evaluated the clinical management and outcome of their offspring. In addition, we sought to determine cases of infectious syphilis (primary, secondary, and early latent syphilis) reported to the Swiss Federal Office of Public Health in women of childbearing age, which has previously been shown to precede changes in the incidence of congenital syphilis within a population. Out of 13,833 women who gave birth at our institution, positive syphilis serology was found in 9 pregnant women during the 10 years studied. A total of 6 pregnant women were diagnosed having syphilis infection during pregnancy. Regarding their offspring, 8 of the 9 newborns were tested serologically. One neonate experienced congenital syphilis because the adequately treated mother developed re-infection after treatment. Within the Swiss population, infectious syphilis cases in women of childbearing age increased substantially from 2006 to 2009. The epidemiologic data suggest that congenital syphilis could become a medical problem in Switzerland due to the rise of infectious syphilis cases in women of childbearing age that have been shown to be followed by changes in the congenital syphilis incidence. The persistence of congenital syphilis in Switzerland along with this rise of infectious syphilis in women of childbearing age suggests a potential for improvement of prenatal care and syphilis control programmes.

Congenital syphilis in Switzerland: gone, forgotten, on the return

Acquired syphilis has re-emerged in many Western European countries. In contrast to international guidelines, screening for syphilis in pregnancy is not generally recommended in Switzerland. There has been an increase in the incidence of laboratory syphilis notifications in recent years, regardless of gender and age. We conducted a retrospective study, evaluating the total numbers of pregnant women with positive syphilis serology (Treponema pallidum Particle Agglutination assay, TPPA) from 2000 to 2009, and evaluated the clinical management and outcome of their offspring. In addition, we sought to determine cases of infectious syphilis (primary, secondary, and early latent syphilis) reported to the Swiss Federal Office of Public Health in women of childbearing age, which has previously been shown to precede changes in the incidence of congenital syphilis within a population. Out of 13,833 women who gave birth at our institution, positive syphilis serology was found in 9 pregnant women during the 10 years studied. A total of 6 pregnant women were diagnosed having syphilis infection during pregnancy. Regarding their offspring, 8 of the 9 newborns were tested serologically. One neonate experienced congenital syphilis because the adequately treated mother developed re-infection after treatment. Within the Swiss population, infectious syphilis cases in women of childbearing age increased substantially from 2006 to 2009. The epidemiologic data suggest that congenital syphilis could become a medical problem in Switzerland due to the rise of infectious syphilis cases in women of childbearing age that have been shown to be followed by changes in the congenital syphilis incidence. The persistence of congenital syphilis in Switzerland along with this rise of infectious syphilis in women of childbearing age suggests a potential for improvement of prenatal care and syphilis control programmes.

Improving antenatal care to prevent adverse pregnancy outcomes caused by syphilis

Evaluation of: Hawkes S, Matin N, Broutet N, Low N. Effectiveness of interventions to improve screening for syphilis in pregnancy: a systematic review and meta-analysis. Lancet Infect. Dis. 11(9), 684-691 (2011). Untreated maternal syphilis continues to be an important risk factor for adverse pregnancy outcomes in many developing countries, resulting in spontaneous abortion, stillbirth, premature delivery or perinatal death. In this systematic review and meta-analysis, Hawkes et al. review the effectiveness of interventions to increase the uptake of syphilis screening and treatment in pregnancy. The ten studies they review, published between 1986 and 2008, have a total sample size of more than 41,000. Overall, they showed that interventions to improve the uptake of antenatal screening for syphilis in pregnancy could reduce the syphilis-attributable incidence of stillbirth and perinatal death by 50%. As prevention of congenital syphilis costs less than US$1.50 per woman screened, the investment to scale up antenatal screening programs would be cost effective, would significantly improve pregnancy outcomes and reduce neonatal mortality.

Effectiveness of interventions to improve screening for syphilis in pregnancy: a systematic review and meta-analysis

About 2·1 million pregnant women have active syphilis every year. Without screening and treatment, 69% of these women will have an adverse outcome of pregnancy. The objectives of this study were to review the literature systematically to determine the effectiveness of screening interventions to prevent congenital syphilis and other adverse pregnancy outcomes. We searched four electronic databases and selected studies to examine evidence for effectiveness of interventions on three outcomes: increased uptake of syphilis testing, increased treatment rates, and reduction in adverse pregnancy outcomes. We used fixed effects meta-analysis to estimate pooled relative risks if no or little evidence of heterogeneity between trials existed. Ten studies met the inclusion criteria, including two randomised trials. Only two studies aimed to encourage women to seek care earlier in pregnancy. Nine studies included decentralisation of screening and treatment. The effects of the interventions on uptake of testing for antenatal syphilis and receiving at least one dose of penicillin were variable and could not be combined statistically. Study interventions were associated with a reduction in perinatal death (pooled risk ratio [RR] from three studies 0·46, 95% CI 0·26-0·82) and stillbirth (pooled RR from three studies 0·42, 95% CI 0·19-0·93). The incidence of congenital syphilis was reduced in all four studies that measured this outcome with heterogeneous results. Interventions to improve the coverage and effect of screening programmes for antenatal syphilis could reduce the syphilis-attributable incidence of stillbirth and perinatal death by 50%. The resources required to roll out antenatal screening programmes would be a worthwhile investment for reduction of adverse pregnancy outcomes and improvement of neonatal and child survival. None.

Screening for Syphilis Infection in Pregnant Women: Evidence for the U.S. Preventive Services Task Force Reaffirmation Recommendation Statement

In 2004, the U.S. Preventive Services Task Force strongly recommended that clinicians screen all pregnant women for syphilis infection. To update the evidence on screening pregnant women for syphilis infection. MEDLINE searches from 1 January 2003 through 31 July 2008, recent systematic reviews, reference lists of retrieved articles, and expert suggestions. English-language studies were selected to answer the following 2 questions: Does screening for syphilis in pregnancy reduce the prevalence of congenital syphilis in neonates? Are there harms of screening for syphilis or harms of treatment with penicillin in pregnancy to women or neonates? Randomized, controlled trials; meta-analyses; systematic reviews; cohort studies; and ecologic studies were selected for the potential benefits question. Randomized, controlled trials; meta-analyses; systematic reviews; cohort studies; case-control studies; and large case series were selected for the potential harms question. Information on the study design, selection criteria, demographic characteristics, and clinical outcomes was extracted from each study. One study on benefits evaluated the effect before and after the implementation of a universal syphilis screening program for pregnant women and found reductions in rates of congenital syphilis. Two studies on screening accuracy for syphilis reported false-positive rates of less than 1%. One study that used a large insurance claims database reported an incidence of anaphylaxis after oral penicillin of 0.1 per 10,000 dispensings. In a study from Hungary, oral penicillin in pregnancy was not associated with orofacial clefts. This was a targeted literature search and could have missed small studies on the benefits and harms of screening for syphilis in pregnancy. We did not review evidence on interventions to improve rates of prenatal screening. New evidence from a study of universal screening supports previous evidence on the effectiveness of screening for syphilis in pregnancy to prevent congenital syphilis. Harms include testing and follow-up for false-positive test results and adverse effects from penicillin treatment.

Screening for syphilis in pregnancy: which is the proper method?

Consequences of syphilis in mother, pregnancy, fetus and child are considerable, but preventable. Serological screening must be offered at the first prenatal visit. Presently, the diagnosis of syphilis is dependent mainly on serological tests. The most widely used screening tests for syphilis are the VDRL and the rapid plasma reagin (RPR) and for confirmation the fluorescent treponemal antibody (FTA) and the treponema pallidum hemagglutination (TPHA) tests. The four alternative nodes for diagnosis of can be a) VDRL + FTA, b) VDRL + TPHA, c) RPR + FTA and d) RPR + TPHA. Here the author reports an evaluation of cost utility of those tests in obstetrical practice. According to this study, it can be shown that the cost per accurate diagnosis for VDRL + TPHA is the least expensive choice and for RPR + FTA is the most expensive choice. Therefore, this alternative is the best method for serological diagnosis of syphilis, based on medical laboratory economics principles.

Screening for syphilis in pregnancy: An assessment of the costs and benefits

The substantial decline in the incidence of syphilis, especially in women, in Western Countries since 1945 has led some to question the desirability of continuing routine antenatal serological screening for syphilis in pregnancy. No routine figures are available in England with regard to the incidence of maternal syphilis. The incidence of syphilis in pregnancy was estimated for 1981 by means of a postal questionnaire sent to all the Special Clinics in England, and the costs and benefits of the screening programme were calculated by means of a computer-aided program which included a sensitivity analysis. Under various assumptions, the total cost savings from discontinuing screening ranged from £170479 to £325493 per annum, with a ‘best estimate’ of £252713. Benefits in terms of cost savings to the N.H.S. resulting from the screening programme ranged from £1870705 to £6975587 per annum, with a ‘best estimate’ of £5121950. When other benefits to society of the programme were considered, total benefits ranged from £3243845 to £14121160 per annum with a ‘best estimate’ of £8322610 per annum. The benefit/cost ratio ranged from 9.20 to 1 to 82.83 to 1 with a ‘best estimate’ of 32.93 to 1. It is concluded that, on economic grounds, there is a strong argument for continuing to screen routinely for syphilis in pregnancy.