Emergency Department Screening of Syphilis During Pregnancy

This case report depicts a 39-year-old G7P4024 pregnant female at 10 weeks of gestation with a history significant for polysubstance use, particularly methamphetamine, schizoaffective disorder, and previous syphilis infection. She presented to the psychiatric emergency center under a detention warrant for suicidal ideations. She had previously undergone multiple syphilis screenings in the emergency department throughout her pregnancy and was only found to have a clinically significant rapid plasma reagin (RPR) titer at her first outpatient prenatal visit at 10 weeks of gestation. Over the last decade, the incidence of congenital syphilis has increased steadily in the United States despite widespread access to penicillin. Treponema pallidum infections have a high perinatal infant mortality rate and reduced transmission risk with early treatment. Prompt identification of infection in the mother is imperative to the survival and health of both mother and infant. Healthcare providers should consider increased screening frequency for pregnant patients who are at high risk of acquiring a Treponema pallidum infection, especially in the emergency department.