Currently, the standard recommendation for syphilis screening in pregnancy is for testing to be done in the first trimester or at the first prenatal visit; additional screening is only done in cases where there is clinical suspicion for ongoing risk during pregnancy, such as when a patient is at risk for bloodborne infection. A pregnancy test is recommended for any individual diagnosed with syphilis who is able to become pregnant.
Unfortunately, BC has observed an increase in infectious syphilis and BCCDC has identified two cases of congenital syphilis so far in 2019. BC’s Provincial Health Officer declared a syphilis outbreak in July 2019. Accordingly, revised, interim guidelines for syphilis screening in pregnancy have been released.
In addition to the current practice of testing all pregnant individuals at their first prenatal visit, it is now being recommended that a second screening test be administered at the time of delivery. Time of delivery refers to at time of admission for delivery to a health care facility or any time after 35 weeks gestation for those planning home births.
The overarching goal of these interim guidelines is to maximize detection and prevention of maternal and congenital syphilis, while maintaining a responsible approach to screening.
As with other perinatal screens, syphilis screening remains a choice for pregnant patients and opting out is possible. However, we are considering these guidelines the standard of care and are highly recommending screening due to the infectious, yet treatable nature of syphilis. These recommendations apply to all pregnant individuals, regardless of assessed or perceived risk, and are in line with several other jurisdictions in Canada.
The new BC Public Health Laboratory (PHL) Serology Screening Requisition
is available. Continue to check off Syphilis Antibody (1st Trimester) in the prenatal screening section. Check the box for Perinatal Syphilis for the ‘at delivery’ screen. If using any other requisition (e.g., outpatient maternity requisition), include the gestational age on the requisition.