Maternal reference
Screen early. Recheck. Document.
Screening and a verifiable treatment history connect maternal care to the newborn assessment. This reference does not prescribe adult treatment.
Three routine screening points
ACOG recommends syphilis screening for every pregnant patient at the first prenatal visit, in the third trimester, and at birth. This universal repeat-screening recommendation differs from the risk-based third-trimester and delivery language in the CDC 2021 pregnancy guideline. ACOG practice advisory (April 2024; reaffirmed October 2025).
Understand the testing sequence
| Sequence | Initial test | Next step |
|---|---|---|
| Traditional | Nontreponemal test (RPR or VDRL) | Confirm a reactive result with a treponemal test; obtain a quantitative endpoint titer. |
| Reverse | Treponemal immunoassay | Obtain a quantitative nontreponemal test. If nonreactive, adjudicate with a different treponemal test, preferably TP-PA. |
Interpret discordant results with the history, examination, treatment record, exposure, and follow-up reliability. A treponemal test can remain reactive after treatment and cannot substitute for a quantitative nontreponemal titer. CDC laboratory recommendations, 2024.
Make the treatment record usable
- Document the clinician-established stage, formulation, administered dose, dose count, intervals, completion, and timing relative to delivery.
- Penicillin G is the established treatment for fetal infection prevention; a nonpenicillin regimen does not establish adequate maternal treatment for this newborn framework.
- For a required weekly late-latent course during pregnancy, an interval longer than nine days requires restarting the course.
- The newborn Scenario 3 timing criterion is treatment initiated at least 30 days before delivery with an otherwise adequate completed course.
- Failure to achieve a fourfold titer decline before delivery alone does not establish treatment failure. Review sustained rising titers, new exposure, and reinfection separately.
CDC syphilis during pregnancy · CDC newborn scenarios
At delivery
Establish maternal serologic status before discharge. Late or absent prenatal care with a reactive rapid treponemal test at delivery has a dedicated newborn pathway: confirmatory testing must not delay the indicated evaluation and treatment. Use maternal delivery titers and the same nontreponemal method as the infant, using infant serum obtained after birth.
ACOG clinician FAQs provide additional obstetric implementation guidance. Source verification and clinical review dates are recorded separately on Sources & methods.
Open the newborn assessment →