The Pennsylvania Department of Health (PADOH) is providing the following update in response to a significant increase in the 2018 Congenital Syphilis cases reported in the state. In 2018, a total of 6 congenital syphilis cases were reported in the state (PA exclusive of Philadelphia) which represents the highest number of cases in more than 24 years. Additionally, Early Syphilis reported in women of child bearing age (women age 15 to 44) increased 47% from 87 cases in 2017 to 128 cases in 2018. The 128 cases of Early Syphilis reported in women of child bearing age represents the highest reported number of cases in Pennsylvania (PA Exclusive of Philadelphia) in more than two decades.
In response to the recent increase in both Congenital Syphilis and reported Early Syphilis in women of child bearing age, PADOH is recommending that all pregnant females be offered a test for syphilis at the following intervals:
- At the first prenatal visit;
- At the third trimester of pregnancy;
- At the delivery of a child, or;
- At the delivery of a stillborn child.
This notice is in addition to the statewide requirement for syphilis testing contained in 28 Pa Code § 27.89 (a)(1)(i) that directs a physician who attends, treats or examines a pregnant woman for conditions relating to pregnancy to offer the woman a test for syphilis at the time of first examination.
If a pregnant woman does not object, the test shall be performed in accordance with 28 Pa Code §27.89. If a pregnant woman objects, the regulation requires the person attending the woman to explain to her the need for the test. With respect to the woman who has given birth, information relating to the test or the objection to the test is to be recorded in both the woman’s medical record and in the record of the newborn, as regulation states.
In addition, all patients presenting with any of the following symptoms or conditions should be tested for syphilis:
- A macular and/or papular rash on the palms of the hands or on the soles of the feet
- A generalized rash that may be macular, papular, or papulosquamous on the back, chest, or stomach
- A lesion in the genital, rectal, or oral area
- Moist papules in the anogenital region or the mouth
- Sudden “Moth-eaten” scalp alopecia with a typical onset at the back of the head
- Loss of eyelashes and the lateral third of the eyebrows
- Generalized lymphadenopathy
- A recent positive test for another sexually transmitted disease such as gonorrhea or chlamydia
Additional information on the treatment and follow-up of syphilis is also available by consulting the CDC’s “Sexually Transmitted Diseases Treatment Guidelines – 2015,” that is available on the internet at www.cdc.gov/std/treatment/ .
Parenteral Benzathine penicillin G is the only therapy with documented efficacy for syphilis during pregnancy. Pregnant women with syphilis in any stage who report penicillin allergy should be desensitized and treated with Benzathine penicillin G. Due to the recent changes in health care delivery, some providers have not been able to obtain cost-effective access to Benzathine penicillin G for their at-risk pregnant clients. In these situations, providers are strongly encouraged to contact the Pennsylvania Department of Health for treatment assistance.
Special Note for Sexually Active Females of Child Bearing Age
Due to the recent spike in congenital syphilis cases and a general increase of reported STDs among females, PADOH is recommending statewide that all sexually active females of child bearing age be routinely screened for HIV, Syphilis, Gonorrhea and Chlamydia. Females who do not have insurance, or are under insured, can receive free and confidential HIV and STD testing services at any of the statewide STD clinics. For a current list of free and confidential HIV and STD testing sites, please go online at www.health.state.pa.us/std
Physicians needing additional information are asked to call the following number:
Pennsylvania Department of Health
Bureau of Communicable Diseases
Page 3 of 3 – Advisory #439
Division of TB/STD
8:00 A.M. – 5:00 P.M.
Additional Web Links
Additional information on syphilis testing and treatment for pregnant women can be found online at: www.cdc.gov/std/treatment
Originally released by the Pennsylvania Department of Health on March 22, 2019.