Is antenatal screening for syphilis worth while?

To ascertain the effectiveness of an antenatal screening programme for syphilis, a review of the seven-year period from 1981 to 1987, was made at The Royal Women's Hospital, Melbourne. In total, 35,103 patients were screened, with a biological false-positive rate of 0.3%. Serological evidence of treponemal infection occurred in 0.4% of patients, with 66% of this group being newly recognized cases. Eight (0.02%) cases were consistent serologically with early treponemal infection, although clinically all patients were asymptomatic at the time of detection. The outcome in infants was satisfactory in all cases where appropriate antibiotic therapy was instituted antenatally. In one case, which presented late at 32-weeks' gestation for the first antenatal visit, the result was a fetal death in utero. The post-mortem findings were compatible with a diagnosis of congenital syphilis. At an incidence of 0.02% for active maternal syphilis, and an over-all treponemal infection rate of 0.4%, the cost-effectiveness of antenatal screening is well-justified.