University of Iowa, Iowa City.
Fairfax Family Practice Residency, Fairfax, Virginia.
JAMA. 2018 Sep 4;320(9):911-917. doi: 10.1001/jama.2018.11785.
Untreated syphilis infection in pregnant women can be transmitted to the fetus (congenital syphilis) at any time during pregnancy or at birth. Congenital syphilis is associated with stillbirth, neonatal death, and significant morbidity in infants (eg, bone deformities and neurologic impairment). After a steady decline from 2008 to 2012, cases of congenital syphilis markedly increased from 2012 to 2106, from 8.4 to 15.7 cases per 100 000 live births (an increase of 87%). At the same time, national rates of syphilis increased among women of reproductive age.
To update the US Preventive Services Task Force (USPSTF) 2009 recommendation on screening for syphilis infection in pregnant women.
The USPSTF commissioned a reaffirmation evidence update to identify new and substantial evidence sufficient enough to change its prior recommendation. Given the established benefits and practice of screening for syphilis in pregnant women, the USPSTF targeted its evidence review on the direct benefits of screening on the prevention of congenital syphilis morbidity and mortality and the harms of screening for and treatment of syphilis infection in pregnant women.
Using a reaffirmation process, the USPSTF found that accurate screening algorithms are available to identify syphilis infection. Effective treatment with antibiotics can prevent congenital syphilis and significantly decrease adverse pregnancy outcomes, with small associated harms, providing an overall substantial health benefit. Therefore, the USPSTF reaffirms its previous conclusion that there is convincing evidence that screening for syphilis infection in pregnant women provides substantial benefit.
The USPSTF recommends early screening for syphilis infection in all pregnant women. (A recommendation).
孕妇未经治疗的梅毒感染可在妊娠期间的任何时间或分娩时传染给胎儿（先天性梅毒）。先天性梅毒与死产、新生儿死亡以及婴儿严重发病（例如，骨骼畸形和神经损伤）相关。自 2008 年至 2012 年稳步下降后，先天性梅毒病例从 2012 年至 2016 年大幅增加，每 10 万活产儿中有 8.4 至 15.7 例（增加了 87%）。与此同时，育龄妇女的梅毒全国发病率也有所上升。
更新美国预防服务工作组（USPSTF）2009 年关于孕妇梅毒感染筛查的建议。
USPSTF委托进行了一次重新确认证据更新，以确定新的、充分的实质性证据，足以改变其先前的建议。鉴于在孕妇中筛查梅毒的既定益处和做法，USPSTF 将其证据审查重点放在筛查对预防先天性梅毒发病率和死亡率的直接益处，以及筛查和治疗孕妇梅毒感染的危害上。
USPSTF 通过重新确认程序发现，现已有可用于识别梅毒感染的准确筛查算法。用抗生素进行有效治疗可以预防先天性梅毒，并显著降低不良妊娠结局的风险，同时伴随很小的相关危害，从而带来整体的实质性健康益处。因此，USPSTF 再次确认其先前的结论，即有确凿证据表明筛查孕妇梅毒感染可带来实质性益处。
USPSTF 建议对所有孕妇进行早期梅毒感染筛查。（A 级推荐）
