NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Screening for Syphilis Infection in Pregnant Women: A Reaffirmation Evidence Update for the U.S. Preventive Services Task Force
Evidence Synthesis, No. 167
Investigators: Jennifer S. Lin, MD, MCR, Michelle Eder, PhD, and Sarah Bean, MPH.
Structured Abstract
Objective:
To systematically update the evidence for three questions to support updating the 2009 USPSTF A recommendation for screening for syphilis in pregnancy: KQ1) effectiveness of screening to reduce the incidence of congenital syphilis or other adverse pregnancy outcomes of syphilis, KQ2) harms of screening in pregnancy, and KQ3) harms of penicillin in pregnancy.
Data Sources:
We conducted a literature search of MEDLINE, PubMed Publisher-Supplied Records, and the Cochrane Central Register of Controlled Trials (CENTRAL) from January 1, 2008 to June 2, 2017.
Study Selection:
We screened 453 abstracts and 34 full-text articles against a priori inclusion criteria. We included studies conducted in countries categorized as “high” or “very high” on the Human Development Index.
Data Analysis:
Two investigators independently critically appraised each article that met inclusion criteria using design-specific criteria. We abstracted and narratively synthesized data from included studies.
Results:
We included one study for KQ1, six studies for KQ2, and no studies for KQ3. For KQ1, we included one study reporting longer-term follow-up from a previously included study. This observational study evaluated the implementation of syphilis screening in pregnancy in over 2 million women in China. From 2002 to 2012, screening for syphilis in all pregnant women increased from 89.8 percent to 97.2 percent, and the incidence of congenital syphilis decreased from 109.3 to 9.4 cases per 100,000 live births. For KQ2, we included five studies evaluating the false positives of treponemal tests (i.e., CIA, EIA, and TPPA) and one study evaluating the false negatives of nontreponemal tests (i.e., RPR). These studies found that false positives with EIA or CIA were common (46.5 to 88.2 percent), therefore warranting reflexive testing for all CIA or EIA test positives. One study demonstrated that 2.9 percent of discordant samples (RPR negative/TPPA positive) had a false-negative RPR test due to the prozone phenomenon.
Limitations:
Our review was designed to identify evidence that could result in a change in the 2009 USPSTF recommendation and therefore our review does not address the effectiveness of screening or early prenatal care in low- or middle-income countries, the comparative screening accuracy of traditional versus reverse sequence algorithm testing, or the efficacy of penicillin G or alternative antibiotic treatments for the treatment of syphilis.
Conclusions:
Screening for syphilis in pregnancy is standard of care in the United States. Our brief evidence update found evidence that is consistent with the understanding that screening for syphilis in pregnancy reduces congenital syphilis and supports the need for reflexive testing to investigate discordant EIA/CIA positive/RPR negative testing in reverse sequence screening algorithms.
Contents
Suggested citation:
Lin JS, Eder M, Bean S. Screening for Syphilis Infection in Pregnant Women: A Reaffirmation Evidence Update for the U.S. Preventive Services Task Force. Evidence Synthesis No. 167. AHRQ Publication No. 18-05238-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2018.
This report is based on research conducted by the Kaiser Permanente Research Affiliates Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA-290-2012-00015-I, Task Order No. 5). The findings and conclusions in this document are those of the authors, who are responsible for its contents, and do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information (i.e., in the context of available resources and circumstances presented by individual patients).
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.
- NLM CatalogRelated NLM Catalog Entries
- Review Screening for Syphilis Infection in Pregnant Women: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.[JAMA. 2018]Review Screening for Syphilis Infection in Pregnant Women: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.Lin JS, Eder ML, Bean SI. JAMA. 2018 Sep 4; 320(9):918-925.
- Review Lipid Screening in Childhood and Adolescence for Detection of Familial Hypercholesterolemia: A Systematic Evidence Review for the U.S. Preventive Services Task Force[ 2016]Review Lipid Screening in Childhood and Adolescence for Detection of Familial Hypercholesterolemia: A Systematic Evidence Review for the U.S. Preventive Services Task ForceLozano P, Henrikson NB, Dunn J, Morrison CC, Nguyen M, Blasi PR, Anderson ML, Whitlock E. 2016 Aug
- Review Nontraditional Risk Factors in Cardiovascular Disease Risk Assessment: A Systematic Evidence Report for the U.S. Preventive Services Task Force[ 2018]Review Nontraditional Risk Factors in Cardiovascular Disease Risk Assessment: A Systematic Evidence Report for the U.S. Preventive Services Task ForceLin JS, Evans CV, Johnson E, Redmond N, Burda BU, Coppola EL, Smith N. 2018 Jul
- Review Lipid Screening in Childhood for Detection of Multifactorial Dyslipidemia: A Systematic Evidence Review for the U.S. Preventive Services Task Force[ 2016]Review Lipid Screening in Childhood for Detection of Multifactorial Dyslipidemia: A Systematic Evidence Review for the U.S. Preventive Services Task ForceLozano P, Henrikson NB, Morrison CC, Dunn J, Nguyen M, Blasi P, Whitlock EP. 2016 Aug
- Review Screening for Adolescent Idiopathic Scoliosis: A Systematic Evidence Review for the U.S. Preventive Services Task Force[ 2018]Review Screening for Adolescent Idiopathic Scoliosis: A Systematic Evidence Review for the U.S. Preventive Services Task ForceDunn J, Henrikson NB, Morrison CC, Nguyen M, Blasi PR, Lin JS. 2018 Jan
- Screening for Syphilis Infection in Pregnant Women: A Reaffirmation Evidence Upd...Screening for Syphilis Infection in Pregnant Women: A Reaffirmation Evidence Update for the U.S. Preventive Services Task Force
- maturase K, partial (chloroplast) [Loxanthocereus otuscensis]maturase K, partial (chloroplast) [Loxanthocereus otuscensis]gi|2240035575|gb|UQT19633.1|Protein
Your browsing activity is empty.
Activity recording is turned off.
See more...