Don’t miss syphilis in pregnant women
Don’t miss syphilis in pregnant women
The only prenatal care that some high-risk pregnant women receive is episodic care in the ED, according to William Dumas, RN, director of clinical services for the Massachusetts Department of Public Health Division of STD Prevention in Jamaica Plain. The Atlanta-based Centers for Disease Control and Prevention recommends that pregnant women be screened for syphilis in EDs during the early stages of pregnancy, especially women at high risk. "Screening can help to detect syphilis in these patients, and this might be the only opportunity before delivery to diagnose and treat for syphilis," warns Dumas.
You must take advantage of this opportunity to prevent congenital syphilis, he emphasizes. "By identifying and treating a pregnant woman, you can prevent infection in the baby and prevent the spread of syphilis to others if it is in the infectious stage," says Dumas.
Current Syphilis Statistics |
In a 1998 national survey, only 85% of OB/GYNs reported routinely screening pregnant women for syphilis. |
The syphilis rate among infants in 2000 declined by 51% since 1997, the year before the Centers for Disease Control and Prevention (CDC) launched its national syphilis elimination campaign. |
From 1997 to 2000, congenital syphilis rates declined 59.7% for African-Americans, 58.3% for whites, 32.5% for Hispanics, and 29.8% for Asian/Pacific Islanders. |
In 2000, 2,219 infectious syphilis cases among women of childbearing age (ages 15-44) were reported to the CDC, a 38% drop from 3,590 cases in 1997. |
Left untreated, up to 40% of congenital infections will result in infant death. |
Source: Centers for Disease Control and Prevention, Atlanta. |
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Here are interventions you should take:
• Perform a thorough assessment. As an ED nurse, you are on the "front line of syphilis prevention," says Dumas. "Every pregnant woman seen in the ED should have a comprehensive history taken, including prenatal care, sexual history, and risk profile," he advises. The clinical exam should include a genital exam and examination of the skin, including palms and soles, says Dumas. "Obtain a serological test for syphilis, and request a RPR [rapid plasma reagin]-card test if available. Based on the RPR result and/or the physical exam, treatment may be initiated at that time," he says.
• Obtain contact information. Find out where the patient can be contacted if follow-up is required, says Dumas. "Immediately report the case to the health department for further treatment and follow-up as necessary," he adds. Give referrals to women that are not receiving prenatal care, Dumas adds. "ED nurses should also raise the issue of disease intervention for the male partner to prevent reinfection," he says.
• Screen all pregnant women. All pregnant women should be screened for syphilis and offered HIV testing by their provider, says Dumas. "When you screen pregnant women for syphilis, you are trying to prevent a congenital case of syphilis and infection among the woman’s sexual partner or partners," says Dumas. Congenital syphilis is entirely preventable when screening recommendations are followed, he adds. "Unfortunately, not all women who are pregnant have access to prenatal care or will obtain it," he says.
Signs and symptoms are often present for some women that contract syphilis, Dumas acknowledges. "But up to 50% of women will have no visible signs or symptoms," he says. "So the only way to pick up the syphilis infection would be to obtain a serology."
Although CDC statistics indicate that minority groups, especially African-Americans, continue to be disproportionately affected by syphilis, Dumas stresses that all pregnant women should be screened for syphilis no matter their racial or ethnic background. "Risk is determined by behavior, not on race/ethnicity, so it is important to take a social and sexual history as well," he says.
All pregnant women should be screened in the early stages of pregnancy, says Dumas. "ED nurses should check with their state health department regarding what regulation they have in place regarding screening for syphilis," he says. "For example, some states mandate screening at delivery for all women."
Sources
For more information about screening of pregnant women, contact:
• William Dumas, RN, Massachusetts Department of Public Health, Division of STD Prevention, State Laboratory Institute, 305 South St., Jamaica Plain, MA 02130. Telephone: (617) 983-6950. Fax: (617) 983-6962. E-mail: [email protected].
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