Objective
We sought to determine the clinical utility and cost of repeating syphilis testing
in the third trimester of pregnancy in a high-risk urban population.
Study Design
A retrospective cohort analysis was performed for patients delivering from January
1993 through December 2009 with at least 1 venereal disease research laboratory (VDRL)
test sent during pregnancy. Chart review was performed for patients with confirmed
syphilis to determine the temporal relationship of syphilis diagnosis to the pregnancy.
For patients who seroconverted during pregnancy (no antecedent history or treatment
for syphilis), newborn charts were reviewed. The costs of treating seropositive neonates
and the costs of implementing additional third-trimester syphilis screening were then
compared.
Results
In the 17-year cohort, 58,569 deliveries were available for analysis. In all, 113
new cases of syphilis occurred (192.9/100,000 deliveries). There were 17 detected
seroconversions; 10 were not rescreened in the third trimester and tested positive
at delivery. These 10 patients may have benefitted from implementing uniform VDRL testing at 28-32 weeks' gestation.
All newborns were asymptomatic with a negative workup and received empiric penicillin
therapy. Based on 2011 hospital charges, the cost of evaluating and treating a neonate
for syphilis is $11,079. Implementing an additional VDRL screen at 28-32 weeks' gestation
for each pregnant patient during the 17 years studied would cost $1,991,346. An 18-fold
increase in syphilis prevalence (3500/100,000 [3.5%] deliveries) would be required
for the cost of implementation of universal early third-trimester screening to be
equal to the potential health care charges saved by detecting maternal seroconversion
and obviating the need for neonatal therapy.
Conclusion
In this high-risk population, additional syphilis screening in the third trimester
is costly and is not clinically helpful in detecting maternal seroconversion.
Key words
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References
Centers for Disease Control and Prevention. Syphilis surveillance annual report (all years). Available at: http://www.cdc.gov/std/syphilis/stats.htm. Accessed July 1, 2013.
Ohio Department of Health. Total syphilis statistical summaries 2012. Available at: http://www.odh.ohio.gov/healthStats/disease/std/std1.aspx. Accessed July 1, 2013.
- Screening for syphilis infection in pregnant women: evidence for the US Preventive Services Task Force reaffirmation recommendation statement.Ann Intern Med. 2009; 150: 710-716
- Assessment of the value of rescreening for syphilis in the third trimester of pregnancy.Infect Dis Obstet Gynecol. 2006; 2006: 56504
- Hospitalization cost of congenital syphilis diagnosis from insurance claims data in the United States.Sex Transm Dis. 2013; 40: 226-229
- Missed opportunities for preventing congenital syphilis infection in New York City.Obstet Gynecol. 2012; 120: 882-888
- Missed opportunities for congenital syphilis and HIV perinatal transmission prevention.Rev Saude Publica. 2008; 42: 851-858
- Prenatal screening for infectious diseases and opportunities for prevention.Obstet Gynecol. 2003; 102: 753-760
- Missed opportunities for congenital syphilis prevention in an urban southeastern hospital.Sex Transm Dis. 2011; 28: 92-98
Article info
Publication history
Published online: December 12, 2013
Accepted:
December 8,
2013
Received in revised form:
November 9,
2013
Received:
September 3,
2013
Footnotes
Dr Shiber is now with the Department of Obstetrics and Gynecology, University of Louisville School of Medicine, Louisville, KY.
The authors report no conflict of interest.
Reprints not available from the authors.
Cite this article as: Shiber L, Todia WJ. Cost and clinical utility of repeated syphilis screening in the third trimester in a high-risk population. Am J Obstet Gynecol 2014;210:267.e1-5.
Identification
Copyright
© 2014 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
