Syphilis Screening in Pregnancy and Beyond: Preventing Congenital Syphilis and Destigmatizing Testing

Syphilis rates have continued to rise among reproductive-aged women in the US, heightening concern about congenital syphilis and the need for earlier, repeated screening during pregnancy. At the 2026 American College of Obstetricians and Gynecologists Annual Clinical & Scientific Meeting, Patient Care Online spoke with Kathryn Miele, MD, medical officer at the Centers for Disease Control and Prevention in the Prenatal Exposure Surveillance and Research Team, about how primary care clinicians can help prevent missed opportunities for diagnosis and treatment.

In the video above, Miele discusses ACOG’s recommendation for syphilis screening 3 times during pregnancy: at the initiation of prenatal care, in the early third trimester, and again at delivery. She also emphasizes the importance of screening at the time of pregnancy confirmation for patients who have not yet established prenatal care, including in emergency department or other acute care encounters where pregnancy may first be identified.

Miele also addresses how clinicians can reduce stigma when discussing syphilis testing with patients. She explains that patient education around the potential consequences of untreated syphilis—including vision and hearing loss, miscarriage, stillbirth, neonatal death, and increased risk of HIV acquisition or transmission—can help make screening feel clinically routine rather than judgment-based. Her key message for frontline clinicians is to become more comfortable talking about syphilis, use available resources, and include syphilis testing as part of sexually transmitted infection screening for sexually active patients in areas with high syphilis prevalence.