Syphilis Screening Among Pregnant Individuals in Carceral Settings: Near Misses and a Call to Action

Congenital syphilis is a major global public health problem with cases rapidly increasing in the United States. This article presents a case of an incarcerated pregnant individual who tested negative on routine screening at prison entry, and for whom a third trimester syphilis test likely prevented mother-to-child syphilis transmission. Third trimester syphilis screening in carceral settings is a critical tool in the prevention of congenital syphilis. Yet there are no consensus guidelines recommending universal repeat screening in the third trimester. Many cases of congenital syphilis are missed because of late maternal seroconversion following early-stage syphilis or reinfection, supporting the implementation of universal third trimester screening for syphilis, particularly in carceral settings. The case and reflection on clinical experience of similar cases reported here underscore the importance of universal re-screening for syphilis early in the third trimester to prevent congenital syphilis.