Syphilis Screen at Delivery: A Need for Uniform Guidelines

Sir.—Any effort at controlling the rising incidence of maternal and congenital syphilis requires accurate diagnosis and treatment of maternal syphilis during pregnancy. For women who do not seek antenatal care and those infected late in pregnancy, serologic test for syphilis (STS) at delivery affords the only opportunity to diagnose maternal syphilis and identify the neonate at risk of congenital transmission. Therefore, in areas of high incidence, the Centers for Disease Control and Prevention (CDC) guidelines recommend routine STS early in pregnancy, at 28 weeks' gestation, and at delivery.^1,2 Until recently, the STS at delivery was recommended to be performed on umbilical cord blood samples.³ However, owing to the recent upsurge in the number of cases of congenital syphilis, the weaknesses of cord blood analysis have become apparent. Of particular concern is the possibility of missed diagnosis due to false-negative serology of the cord sample. Hence, in 1989,