Pregnancy Syphilis Screening Gap Raises Congenital Syphilis Concerns

PREGNANCY syphilis screening rates remain high overall, but fewer than one in four pregnancies met all state-required screening milestones, according to a retrospective study of 64,803 pregnancies.¹

The findings point to a significant gap in efforts to prevent congenital syphilis, which occurs when syphilis is transmitted from a pregnant woman to her baby during pregnancy or delivery.¹

The study comes as congenital syphilis rates continue to rise across the United States and in North Carolina. While almost all pregnancies included at least one syphilis test, screening later in pregnancy was frequently not recorded at the time points required under state law.¹

Syphilis is a sexually transmitted infection caused by Treponema pallidum. During pregnancy, untreated infection can be transmitted to the fetus and may increase risk of miscarriage premature birth and stillbirth,² making timely screening and treatment a key component of congenital syphilis prevention.

Pregnancy Syphilis Screening Falls Short of Requirements

Researchers examined 64,803 pregnancies among 54,446 patients who received care within a North Carolina health system between 2019 and 2023.¹ The analysis assessed whether syphilis screening occurred before 28 weeks’ gestation, between 28 and 31 weeks’ gestation, and within one week of delivery, as required by North Carolina law.¹

Overall, 99.5% of pregnancies had at least one syphilis screening recorded.¹ However, only 27.6% had screening documented between 28 and 31 weeks’ gestation, and just 22.0% completed all required screening tests.¹

Marked Differences Across Patient Groups

Women aged 18–24 years were more likely to complete all required screening than those aged 35 years or older (PR 1.15; 95% CI 1.10-1.21).¹ Completion was also higher among uninsured women than among those with private insurance (PR 1.33; 95% CI 1.27-1.39).¹

In contrast, completion rates were lower among Black women than White women (PR 0.93; 95% CI 0.89–0.96) and among women who preferred a language other than English for healthcare communication (PR 0.85; 95% CI 0.81-0.90).¹

The largest disparity was observed among women who initiated care in an emergency department, who were substantially less likely to complete all required screening than those who began care in a women’s health clinic (PR 0.13; 95% CI 0.12-0.15).¹

Implications for Congenital Syphilis Prevention

The findings were based on routinely collected data from a single North Carolina health system and may not capture screening performed outside that network. As a retrospective chart review, the analysis was also dependent on the completeness of medical record documentation.

Despite this, the findings suggest that high rates of at least one syphilis test do not necessarily translate into completion of recommended screening throughout pregnancy. The low rate of adherence to all required screening milestones highlights a major gap in congenital syphilis prevention and underscores the need to improve delivery of pregnancy syphilis screening across the continuum of prenatal care.

References

1. Sweitzer S et al. Gaps in syphilis screening among pregnant women in North Carolina. Sex Transm Dis. 2026;DOI:10.1097/OLQ.0000000000002373.
2. National Health Service (NHS) England. Syphilis. 2026. Available at: https://www.nhs.uk/conditions/syphilis/. Last accessed: 23 June 2026.

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