Affiliation:
1. aCenter for Pediatric Infectious Diseases, Cleveland Clinic Children’s, Cleveland, Ohio
2. bDepartment of Quantitative Health Sciences
3. cQuality and Patient Safety Institute
4. dPathology and Laboratory Medicine Institute
5. eWomen’s Health Institute, Cleveland Clinic, Cleveland, Ohio
Abstract
BACKGROUND
Syphilis screening during pregnancy helps prevent congenital syphilis. The harms associated with false positive (FP) screens and whether screening leads to correct treatments has not been well determined.
METHODS
The population included mothers and infants from 75 056 pregnancies. Using laboratory-based criteria we classified initial positive syphilis screens as FP or true positive (TP) and calculated false discovery rates. For mothers and infants we determined treatments, clinical characteristics, and syphilis classifications.
RESULTS
There were 221 positive screens: 183 FP and 38 TP. The false discovery rate was 0.83 (95% confidence interval [CI], 0.78–0.88). False discovery rates were similar for traditional 0.83 [95% CI, 0.72–0.94] and reverse algorithms 0.83 (95% CI, 0.77–0.88), and for syphilis Immunoglobin (Ig) G 0.79 (95% CI, 0.71–0.86) and total 0.90 (95% CI, 0.82–0.97) assays. FP screens led to treatment in 2 women and 1 infant. Two high-risk women were not rescreened at delivery and were diagnosed after hospital discharge; 1 infant developed congenital syphilis. Among 15 TP women with new syphilis, the diagnosis was before the late third trimester in 14 (93%). In one-half of these women, there was concern for reinfection, treatment failure, inadequate treatment or follow-up care, or late treatment, and their infants did not achieve an optimal syphilis classification.
CONCLUSIONS
Syphilis screening identifies maternal syphilis, but limitations include FP screens, which occasionally lead to unnecessary treatment, inconsistent risk-based rescreening, and among TP mothers failure to optimize care to prevent birth of infants at higher risk for congenital syphilis.
Publisher
American Academy of Pediatrics (AAP)
Subject
Pediatrics, Perinatology and Child Health
Reference26 articles.
1. Centers for Disease Control and Prevention
. Sexually transmitted diseases treatment guidelines, 2021, syphilis during pregnancy. Available at: https://www.cdc.gov/std/treatment-guidelines/STI-guidelines-2021.pdf. Accessed January 19, 2022
2. Syphilis;American Academy of Pediatrics,2021
3. Screening for syphilis infection in pregnant women: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement;Wolff;Ann Intern Med,2009
4. Syphilis in pregnancy;Adhikari;Obstet Gynecol,2020
5. Diagnostic tests for syphilis: New tests and new algorithms;Henao-Martínez;Neurol Clin Pract,2014
Cited by
3 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献