Proposed addition of syphilis re-screening to routine third trimester antenatal blood tests in the Northern Region
Laboratory consultation: Te Whatu Ora Northern Region Laboratories, Labtests, and Northland Pathology
Executive summary
Congenital syphilis rates are increasing in the Northern Region, almost exclusively affecting Māori and Pacific people. We are proposing additional syphilis screening for women in their third trimester. Feedback on this consultation is invited by 24th March 2023
Background
Syphilis in pregnancy can lead to adverse outcomes such as preterm birth, neonatal death, and congenital syphilis. Congenital syphilis can be a debilitating lifelong condition but is preventable if infected mothers are treated adequately in pregnancy. Since 2013, congenital syphilis has been increasing in NZ. Almost all congenital cases have been in the Māori and Pacific populations.
Syphilis testing in pregnancy
Syphilis screening is part of the first trimester antenatal bloods bundle. However, 29% of congenital syphilis cases in NZ occur in women with negative syphilis serology in the first trimester. As such the NZ Sexual Health Society recommends that all women be offered a syphilis rescreen at their second antenatal bloods and in 2020, Counties Manukau introduced routine third trimester rescreening.
What are we proposing?
We are proposing the addition of syphilis testing to the bundled antenatal tests performed at 24-28 weeks (the “second or subsequent” antenatal screen) at all Northern Regions laboratories. Focussed testing for Māori and Pacific women is not appropriate due to issues of identifying the targeted population and potential stigma. As with all bundled tests women can opt out if they choose so.
Why are we proposing this change?
To help reduce lifelong consequences for babies born to mothers with untreated syphilis and the inequities in syphilis associated morbidity for the Māori and Pacific population across the Northern Region districts.
Who is proposing and endorsing this change?
The Northern Region Te Whatu Ora laboratories, Labtests, and Northland Pathology are proposing to make this change. The change is endorsed by the Metro Auckland Sexual Health Governance Group and supported by Infectious Diseases and Maternal-Foetal Medicine physicians in the region.
How would this be done?
All laboratories in the Northern Region will add syphilis to the bundled tests requested as part of the 24-28 week “second or subsequent” antenatal screen.” Laboratory forms will be updated to reflect this (this will take some time) and Labtests eOrders forms will be adapted to reflect this change.
What would do you need to do?
Clinicians would need to be aware of this change in order to provide up to date information for women when they discuss blood tests during pregnancy.
How do we feedback on this consultation?
Any feedback should be directed to Dr Gary McAuliffe, Clinical Microbiologist and Virologist, Te Toka Tumai Auckland: gmcauliffe@adhb.govt.nz
The period of feedback on this consultation is until 24th March 2023. Feedback will be addressed with individuals and groups and a decision communicated on 31st March 2023.
References
New Zealand Sexual Health Society. 2020. NZSHS position statement on re-testing pregnant women for syphilis infection or reinfection. Available at:
https://www.nzshs.org/docman/guidelines/management-of-sexual-health-conditions/syphilis/syphilis-in-pregnancy [Accessed on: 24/02/2023]
Gilmour LS, Best EJ, Duncanson MJ, Wheeler BJ, Sherwood J, Thirkell CE, Walls T. High Incidence of Congenital Syphilis in New Zealand: A New Zealand Pediatric Surveillance Unit Study. Pediatr Infect Dis J. 2022 Jan 1;41(1):66-71.
Morgan J, Mathew T, Azariah S. Eliminating congenital syphilis from Aotearoa New Zealand. N Z Med J. 2021 Oct 22;134(1544):8-12.