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All pregnant women should be screened early for syphilis infection, according to the U.S. Preventive Services Task Force (USPSTF).

The task force commissioned a "reaffirmation evidence update," which targeted its review on direct benefits of the screening process, and reaffirmed that there was "convincing evidence" that screening for syphilis infection in pregnant women provides "substantial benefit" warranting an "A" recommendation, wrote Susan J. Curry, PhD, of the USPSTF, and colleagues in and simultaneously on the

The task force employed a reaffirmation process for this statement, which they said that they reserve for "well-established, evidence-based standards of practice in primary care practice." They added that "only a very high level of evidence would justify a change in the grade of the recommendation."

In this case, the authors found no new studies examining the effectiveness of repeated testing for syphilis during pregnancy and no new evidence that was "inconsistent" with the benefits of screening for syphilis infection in pregnant women, and the potential harms of screening continue to include "false-positive results that require clinical evaluation, unnecessary anxiety to the patient, and harms of antibiotic medication use," they wrote.

When commenting on the draft recommendation statement issued in March, the task force said that several comments requested clearer guidance about the timing of initial syphilis screening.

"Treatment is most effective when it is done early, so we strongly recommend that all women be screened as early in their pregnancy as possible," task force member Melissa A. Simon, MD, said in a statement.

The authors noted that recommended parenteral benzathine penicillin G for treatment of syphilis in pregnant women. But they added that "evidence on the efficacy or safety of alternative antibiotic medications for pregnant women and fetus is very limited," and women with a penicillin allergy should be evaluated and if necessary, desensitized and treated with penicillin. The authors said that clinicians should for "the most up-to-date information."

Another comment asked about risk factors for repeat testing, and the authors cited both CDC guidelines, as well as from the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) that recommend women at high risk be re-screened at approximately 28 weeks gestation.

"Women at include those living in communities or geographic areas with higher presence of syphilis, those living with HIV, and those with a history of incarceration or commercial sex work," the authors wrote.

In an in JAMA Dermatology, Kenneth A. Katz, MD, associate editor of the journal, noted the increase in new syphilis infections, arguing that incidence of congenital syphilis has from 2012 (8.4 cases per 100,000 live births) to 2016 (15.7 cases per 100,000 live births).

He stated that dermatologists can contribute to intervening and controlling congenital syphilis, both by keeping syphilis in mind when formulating a differential diagnosis, as well as being aware of the USPSTF recommendations about syphilis screening both in pregnant women and non-pregnant adults and adolescents who may be at increased risk for syphilis.

"Clinical encounters with persons who meet syphilis screening criteria but who lack signs or symptoms of syphilis should trigger recommendations and/or referrals for syphilis screening," Katz wrote. "[But] gaps in public health and clinical practice remain. Public health authorities and physicians, including dermatologists, must do better."

In their recommendation statement, the task force also recommended "additional studies on the use of different screening algorithms in pregnant women" and research into "optimal rescreening intervals" and populations who might benefit from rescreening.