Interim guidance on perinatal syphilis screening – June 2019

Dear Clinicians,

Please see the recommendation below from the BC Centre for Disease Control (BCCDC):

In April 2019, the first case of congenital syphilis in British Columbia since 2013 was reported. A second case of congenital
syphilis was reported in May 2019 in a stillborn delivered in January 2019. Current practice in BC for prenatal syphilis screening
includes first trimester screening; subsequent syphilis screening is not routinely recommended, however, unless there is
concern for ongoing syphilis risk during pregnancy.

Over the last several years, there has been ongoing discussion between the BCCDC STI team and our expert partners and stakeholders about the best way to approach syphilis screening in pregnancy. Recent epidemiologic syphilis trends seen in BC – including increased overall rates, increased rates in women of childbearing age, along with an increasing number of infectious syphilis cases among males who report both male and female sexual partners – have motivated us to rethink our current approach. Our goal is to maximize detection and prevention of congenital syphilis, while still maintaining a responsible approach to screening. We have therefore developed the following interim guidelines regarding prenatal syphilis screening which will be revised as the epidemiology of syphilis in the province evolves. We anticipate keeping these in place for approximately one year.

Syphilis screening in pregnancy: 

All pregnant individuals should have syphilis screening performed at the following time points:

1. During the first trimester of pregnancy (current recommendation) or at first prenatal visit;
2. At delivery (*new recommendation) 

General:

Any individual of childbearing age and able to get pregnant who is diagnosed with syphilis should have a pregnancy test
performed.

These recommendations apply to all individuals, regardless of assessed or perceived risk, and are in line with several other jurisdictions in Canada.

Please see the FAQ and process algorithm attached for more details.