The Oregon Health Authority’s STD Program and the Oregon Perinatal Collaborative are pleased to release the attached guidance titled “Emerging Practices for Responding to the Congenital Syphilis Emergency in Oregon: Recommendations for Health Care Providers.” In this document you will find best practices and resources for congenital syphilis prevention and recommendations for ways you, your colleagues, your clinics, and your healthcare organizations can increase access to care and improve the quality of care for pregnant people with syphilis and enhance your learning and build partnerships with community and local public health to prevent congenital syphilis.

Key recommendations include:

1. Screen all pregnant people for syphilis regardless of risk and prior screening at three time points during pregnancy, including:
   1. First presentation to prenatal care
   2. Early third trimester (~28 weeks, bundle with the glucose tolerance test), and
   3. Delivery
2. All visits for pregnant people are prenatal visits:
   1. Screen all pregnant people with no, limited, or unknown prenatal care for syphilis at any presentation to care, especially in emergency departments, urgent care clinics, substance use disorder treatment facilities, and carceral settings.
   2. Treat people with positive syphilis screening tests according to the 2021 CDC STI Treatment Guidelines.
   3. For people with symptoms of primary or secondary syphilis, treat immediately. Do not wait for laboratory results to return.
3. Verify the pregnancy status of all pregnancy-capable people with syphilis; if pregnant, treat without delay.

In addition, we’ve included the compiled results of an anonymous prenatal care provider survey inquiring about perceptions of the epidemiology of syphilis in Oregon and practices regarding screening, treatment, and management of syphilis in pregnancy.

Key findings include:

1. 54% of participants accurately perceived syphilis to be increasing dramatically among people who can become pregnant
2. 19% of participants reported being very comfortable with interpreting the results of syphilis serologic testing
3. 96% of participants routinely screen all pregnant patients at the first presentation to prenatal care
4. 69% of participants routinely screen all pregnancy patients in the early third trimester
5. 56% of participants had ever diagnosed a pregnant patient with syphilis and 26% had diagnosed a pregnant patient with syphilis in the prior year

We hope that you find this information useful in your practices. Please do not hesitate to reach out to Tim W. Menza, MD, PhD (timothy.w.menza@oha.oregon.gov) with questions, comments, or concerns regarding the recommendations and data in the document. Thank you for your partnership in addressing the congenital syphilis emergency in Oregon.

Tim W. Menza, MD, PHD (he/they)
Medical Director
HIV/STD/TB Section
Public Health Division
Oregon Health Authority
Assistant Professor
Division of Infectious Diseases
Oregon Health & Science University

Email: timothy.w.menza@oha.oregon.gov