Prenatal Syphilis Screening Mandates – Center for Health Decision Science

Sarah Baum, doctoral student in Global Health and Population, and CHDS faculty Nicolas Menzies recently published a study in JAMA Health Forum that analyzed more than 16 million births across 33 U.S. states between 2012 and 2022 to examine policies that require clinicians to offer syphilis screening at multiple points during pregnancy in addition to early prenatal testing. It is already known that expanded prenatal syphilis screening mandates boost detection initially but their effects fade within a year. Moreover, congenital syphilis, which is transmitted from a pregnant patient to their infant, has increased sharply in the U.S. over the past decade and can result in stillbirth, neonatal death, and long-term health complications. Early detection and treatment are highly effective at preventing these outcomes, making timely screening a central component of public health responses.

The authors’ analysis showed that expanded screening requirements were associated with a 26% increase in maternal syphilis case detection immediately after implementation; however, the gains were not sustained—they were no longer statistically significant within one year. This suggests that while mandates can increase testing in the short term, they may not fully overcome barriers to care or facilitate physician adherence to screening requirements, both of which may contribute to the fade-out in effects. The authors conclude that screening mandates are unlikely to be sufficient on their own and should be paired with complementary interventions to sustain improvements in detection and prevention.

Learn more: Read the JAMA Health Forum article, Prenatal Syphilis Screening Mandates and Maternal Syphilis Case Detection
Learn more: Read the Harvard Chan School news, Congenital Syphilis, on the Rise, Requires Response Beyond Screening Mandates