“Almost 90% of cases of congenital syphilis could have been prevented with timely testing and treatment,” said Michael Silverstein, M.D., M.P.H, vice chair of the Task Force. “It is essential to address barriers to care to ensure that all pregnant people get screened and those who screen positive receive timely, equitable, and evidence-based care.”
We spoke with Dr. Silverstein—Director of the Hassenfeld Child Health Innovation Institute and George Hazard Crocker University Professor of Health Services, Policy, and Practice at the Brown University School of Public Health—about the rise of syphilis in the U.S. and the USPSTF’s recommendations.
Why do you think there’s been such a rise in congenital syphilis cases over the last 10 years?
I can’t say with certainty why this is happening. The task force is deeply concerned about it, which is why our recommendation is so important. Screening for syphilis among pregnant people is incredibly effective, and it plays a critical role in addressing this issue.
Can you clarify how early screening can help prevent congenital syphilis?
If a pregnant person has an active syphilis infection, it poses serious risks to their health and to the fetus or infant. These risks include preterm birth, hearing and vision impairment, stillbirth or even infant death. Fortunately, syphilis is highly treatable, particularly when caught early in pregnancy. Screening allows us to detect the infection and treat it with antibiotics, which can prevent about 90% of congenital syphilis cases. Treating the pregnant person effectively prevents the baby from being born with the infection or experiencing its severe consequences.
What are the biggest challenges to testing and treating syphilis during pregnancy?
The biggest barrier is access to prenatal care. Screening for syphilis has been standard practice for a long time, and our task force recommendation reinforces that. However, if pregnant people don’t have consistent access to prenatal or primary care, they’re less likely to be screened. Ensuring equitable access to prenatal care is crucial for widespread screening and prevention.
How do you think the updated recommendation will affect the way doctors and health systems handle cases of congenital syphilis?
My hope is that it reinforces the importance of what’s already a highly effective practice. While the recommendation itself hasn’t changed, renewing it keeps the issue at the forefront of public health priorities. It emphasizes how essential screening is in preventing congenital syphilis.
How will public comments during this feedback period shape the final recommendation? Are there any specific areas where you’re seeking input?
The task force values public feedback tremendously. We put draft recommendations out for comment to ensure transparency and to improve our work in ways we might not anticipate. We don’t usually ask for feedback in specific areas, but we rigorously review every comment and discuss how they might inform our final recommendations. Often, this feedback helps clarify language or highlights areas where additional information would be helpful.
For this particular recommendation, because it’s already a high-priority recommendation with the highest grade, we don’t expect to change its core message or bottom line. However, we’re always open to hearing from the public and improving the clarity and accessibility of our work.
And just to reiterate: The Preventive Services Task Force continues to strongly recommend that all pregnant people be screened for syphilis as early in their pregnancy as possible. This is the most effective way to protect their health and the health of their baby. Early screening remains a vital public health measure.
