Rising Syphilis Rates Demand Enhanced Screening for Pregnant Individuals in Jails and Prisons
Chapel Hill, NC—A newly published case study in the Journal of Correctional Health Care highlights the urgent need to strengthen syphilis screening protocols for pregnant individuals in U.S. Jails and prisons. Researchers at the University of North Carolina (UNC) Institute for Global Health and Infectious Diseases found that a single third-trimester syphilis test likely prevented congenital syphilis in an incarcerated pregnant patient, underscoring a critical gap in national screening guidelines.
The Growing Threat of Congenital Syphilis
The U.S. Has experienced a concerning rise in congenital syphilis cases, climbing from 12.4 per 100,000 live births in 2015 to 109.6 in 2024, marking the 12th consecutive year of increase, according to data from the Centers for Disease Control and Prevention (CDC). In North Carolina alone, cases increased by 36% in 2022. Pregnant individuals with a history of incarceration are at significantly higher risk of contracting syphilis, making consistent and repeated screening a public health priority.
The Case for Third-Trimester Screening
The study focused on a 35-year-old incarcerated pregnant patient who initially tested negative for syphilis during routine early pregnancy screenings. However, a palmar rash in the third trimester prompted repeat testing, which revealed a new infection requiring immediate treatment. Timely intervention prevented congenital syphilis in the infant, who received necessary evaluation and care. Researchers observed similar instances within the statewide prison prenatal system where third-trimester screening could have prevented congenital syphilis but was missed due to a lack of standardized repeat testing.
Guideline Discrepancies and the Call for Universal Screening
Despite evidence suggesting that early serologic tests can miss recent infections or reinfections, there is currently no national consensus on universal third-trimester screening. Recommendations vary:
- The American College of Obstetricians and Gynecologists (ACOG) recently adopted universal third-trimester screening.
- The U.S. Preventive Services Task Force (USPSTF) reaffirmed early screening only, citing insufficient evidence for universal repeat testing.
- The CDC recommends third-trimester testing only for those deemed at elevated risk, which includes incarcerated individuals.
This inconsistency leaves many carceral systems without policies requiring routine third-trimester syphilis tests, despite the heightened risk and limited access to consistent prenatal care for this population.
Preventability and the Ethical Imperative
With 88% of congenital syphilis cases in 2022 deemed preventable with timely testing and treatment, the study authors advocate for universal third-trimester syphilis screening in all U.S. Jails and prisons.
“This case is a warning we can’t afford to ignore,” said Dr. Lina Rosengren, associate professor of medicine at UNC. “We are calling for universal third-trimester syphilis screening in all carceral settings because too many mothers and infants are slipping through gaps in the system. The evidence is clear and the time to act is now.”
About the UNC Institute for Global Health and Infectious Diseases
Established in 2007, the UNC Institute for Global Health &. Infectious Diseases at the University of North Carolina at Chapel Hill conducts research and training to address global health issues, including emerging pathogens, women’s health and vector-borne diseases.