In the past several years the incidence of syphilis increased dramatically in Virginia and nationally. Between 2018 and 2022, the rate of total early syphilis in Virginia increased 14% from 15.7 to 17.9 per 100,000. So far in 2023, syphilis case reports are 22% higher than for the equivalent period in 2022. We have also observed dramatic increases in the incidence of congenital syphilis, a preventable diagnosis with potentially severe consequences for infected infants. To help mitigate the transmission of STIs and their sequalae, please consider the following recommendations and prevention tools:
- Take a thorough sexual health history from all patients as part of routine medical care.
- Test for sexually transmitted infections (STIs) following CDC’s screening guidelines for all patient populations.
- Screen all pregnant women for syphilis during the first trimester or at their initial prenatal visit.
- Re-screen pregnant women for syphilis early in the third trimester (28-32 weeks) and again at delivery if at higher risk (lives in a community with high syphilis morbidity or is at risk for syphilis acquisition during pregnancy (drug misuse, STIs during pregnancy, multiple partners, a new partner, partner with STIs).
- Test for syphilis at the time of delivery in all women who deliver a stillborn infant (after 20 weeks).
- Test for syphilis at delivery, or before discharge from the hospital, for women who did not receive any prenatal care and/or who were not screened during pregnancy.
- Stage syphilis correctly to ensure appropriate treatment. Assess for signs and symptoms of syphilis in last 12 months to determine if early or late syphilis.
- Refer to the CDC STD Treatment Guidelines for syphilis for full details on the recommended treatment regimen for each syphilis stage.
- Benzathine penicillin G in a regimen appropriate for the stage of infection is the only recommended treatment for syphilis during pregnancy. Patients who are allergic to penicillin must be desensitized and treated with benzathine penicillin G.
- Pregnant women diagnosed with late syphilis must be treated with 3 doses 7 days apart.
- Pregnant women who miss any doses must repeat the full course of therapy.
- Perform HIV testing for all women diagnosed with syphilis.
- Report syphilis diagnoses to your local health department as soon as possible.
- Inform your patients diagnosed with syphilis that the health department will contact them to offer follow-up counseling and confidential partner services.
- Disease Intervention Specialists (DIS) are public health staff who are trained to follow up with partners and offer testing and treatment services. They can also assist with the staging of syphilis diagnoses.
- It is important that all partners of patients diagnosed with syphilis are also tested and treated to prevent reinfections and further transmission.
Laboratory Testing and Screening
- CDC Syphilis Laboratory Information
- CDC STD Screening Recommendations
- Syphilis screening recommendations in Virginia
- Recommended clinician timeline for screening during pregnancy
- VDH STD/HIV Testing Locations and Information
Treatment Guidelines and Clinician Resources
- CDC Treatment Guidelines
- Resources for Clinicians
- VDH Resources for Health Professionals
- VDH Syphilis Guide for Providers
- CDC Taking a Sexual History
- NCSD Sexual Health and Your Patients: A Provider’s Guide
- CDC Recommendations for Providing Quality STD Clinical Services
- VDH Resource Connections- hub for HIV, STI and other related services available for referral
- DoxyPEP Factsheet (for Providers)
- DoxyPEP Factsheet (for Patients)