Routine Serological Screening for Syphilis During Pregnancy — Disposable Anachronism or Fundamental Necessity?

EDITORIAL COMMENT: When the editor spent his sabbatical leave in Johns Hopkins Hospital in 1968 he was surprised to see that there was a medical department concerned with medical communication where research was done on whether or not it was possible to encourage the medical staff to read reports of special investigations. Reports were masked and with great publicity the staff could be encouraged to read as many as 75% of all results but the number lapsed back to less than 50% when the policy of encouragement was discontinued! How many results from Pathology Departments are never read by the clinician who ordered them? Recently the editor saw a patient, an unmarried immigrant from Vietnam, at her second antenatal visit, at 22 weeks' gestation, with a copper‐coloured generalized rash and snail‐track ulcers on the side of her tongue — it was then noted that the serology report in her history recorded strongly positive tests for syphilis on the specimen collected 5 weeks previously at the first antenatal visit. Surely there should be a mechanism in all Pathology Departments where important positive findings result in an immediate phone call to the responsible clinican. In his youth, the editor also saw a patient admitted to a teaching hospital with a Stage 2 invasive carcinoma of the cervix and there, in her history, was her last postnatal cervical smear, never acted upon, reporting markedly abnormal cellular findings. These rare accidents can still happen today especially now there are more test results to read! A broader issue is the need to audit the results of all investigations deemed important enough to be performed on all patients. This applies to ultrasonography, cardiotocography, biochemistry tests such as those for fetoplacental function, tests for urinary tract infection and serology tests. This report from Hong Kong presents a model audit of serological screening for syphilis and shows convincingly that the test is still necessary. It confirms the findings recently published from the Royal Women's Hospital, Melbourne A , and Editorial opinions from Australia B, C and England D , which should convince any reader that routine antenatal screening for syphilis is not only cost‐effective but is a valuable public‐health measure that must continue — even in countries in which the disease has a relatively low prevalence. A. Garland SM, Kelly VN. Is antenatal screening for syphilis worthwhile? Med J Aust 1989; 151: B. Gilbert G L. Congenital syphilis — should we worry? Med J Aust 1988; 148:162–163. C. Pritchard R C, Hudson B J. Antenatal screening for syphilis. Med J Aust 1989; 151:363–364. D. Clay J C, Antenatal screening for syphilis — Must continue. Br Med J 1989; 299: 409–410. Summary: Between 1984 and 1988 inclusive 34 patients with syphilis during pregnancy were identified in this unit by routine serological screening. There were 2 stillbirths in this group of patients giving a perinatal mortality rate of 59 per 1,000 total births. Analysis of the patients' history and physical examination findings did not reveal any predictive factors for sexually transmitted diseases in most cases. Despite the dramatic fall in the prevalence of syphilis both during pregnancy and the general population in Hong Kong, routine serological screening for syphilis during pregnancy must continue.