State laws on syphilis screening in pregnancy vary. (Often Poorly Implemented).

BANEF, ALTA. -- Despite abundant state laws mandating syphilis screening during pregnancy, the content of such laws varies greatly, and most are inconsistent with syphilis screening recommendations made by the American College of Obstetricians and Gynecologists, Dr. James Hill reported.

In an overview of such legislation in the 50 states plus the District of Columbia, Dr. Hill explained how 13 states with significant syphilis problems lack laws mandating screening in the third trimester. (See box on next page.)

That's important because, as previous surveys from a large series in Atlanta have shown, as many as 25% of congenital syphilis cases can be attributed to preventable missed opportunities for screening during the third trimester, Dr. Hill of the University of Texas Southwestern Medical Center, Dallas, said in an interview. He presented his findings in poster form at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

Current guidelines from ACOG and the American Academy of Pediatrics recommend that all women be screened for syphilis at the first prenatal visit; women considered to be at high risk for the disease should be screened again at 32-36 weeks' gestation. Similarly, the AAP's Red Book 2000 advises screening early in pregnancy and preferably again at delivery.

Furthermore, the Centers for Disease Control and Prevention recommends retesting at 28 weeks for women who are at high risk of the disease or who live in a state deemed to have a high prevalence of maternal syphilis.

Of the 46 states that have laws regarding antepartum syphilis screening, 34 mandate one prenatal test, usually at the first prenatal visit or shortly thereafter. Only 12 states mirror professional medical society recommendations by requiring third-trimester screening for all or high-risk women. Additionally, three states require maternal or cord blood screening at delivery.

To some degree, individual clinicians are screening patients for syphilis, identifying the disease, and treating it before it is passed to the infant. But despite professional society guidelines, "it appears that ob.gyn. physicians screen variably early in pregnancy, he said.