Draft Research Plan
Syphilis Infection in Pregnant Women: Screening
June 08, 2017
Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Figure 1 is the analytic framework that depicts the three Key Questions to be addressed in the systematic review. The figure illustrates how screening for syphilis infection in asymptomatic pregnant women may result in improved health outcomes, including decreased vertical transmission of syphilis and reduced maternal and infant morbidity and mortality (Key Question 1). Additionally, the figure illustrates whether screening for syphilis infection in pregnant women is associated with any harms (Key Question 2). The figure also shows whether treatment to prevent vertical transmission of syphilis is associated with any harms (Key Question 3).
- Does screening for syphilis in pregnant women reduce the prevalence of congenital syphilis in newborns?
- What are the harms of screening for syphilis in pregnant women?
- What are the harms of treatment of syphilis with penicillin during pregnancy to pregnant women or newborns?
The Proposed Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Review. Criteria are overarching as well as specific to each of the key questions (KQs). The Reaffirmation Evidence Update for this topic will be conducted using rapid synthesis procedures, as described in Section 4.7 of the USPSTF Procedure Manual (available at https://www.uspreventiveservicestaskforce.org/Page/Name/methods-and-processes).
| Included | Excluded | |
|---|---|---|
| Populations | KQs 1, 2: Asymptomatic, pregnant adolescent or adult women, at any time during pregnancy, who are not known to have syphilis infection
KQ 3: Studies of penicillin treatment in pregnant women with syphilis infection |
KQs 1, 2: Women who are known to have syphilis infection, have symptoms, or are not pregnant; studies in women living with HIV (for whom syphilis testing is considered disease management rather than a screening intervention)
KQ 3: Studies of penicillin treatment in nonpregnant women or men; studies of penicillin treatment for any condition other than syphilis |
| Interventions | KQs 1, 2: Two-step screening for syphilis with a nontreponemal and treponemal test
KQ 3: Treatment of syphilis with penicillin initiated during pregnancy |
KQs 1, 2: Screening tests not currently used in U.S. primary care settings
KQ 3: Other types of treatment of syphilis; treatment of syphilis with penicillin not initiated during pregnancy |
| Comparisons | KQ 1: No screening
KQ 2: No comparator necessary for studies on psychosocial harms; studies on screening test accuracy reporting on false-positive and false-negative results must include a reference standard (e.g., a treponemal test) KQ 3: No comparator necessary |
KQ 1: Alternate screening strategy or no comparator |
| Outcomes | KQ 1: Vertical transmission of syphilis; prevalence of congenital syphilis after implementation of a screening program; maternal or infant morbidity and mortality
KQ 2: Harms of screening (e.g., false-positive and false-negative results, labeling, psychosocial harms) KQ 3: Harms of treatment of syphilis with penicillin during pregnancy (e.g., allergic reaction, fetal harms) |
Cost-effectiveness or cost-related outcomes |
| Setting | Primary care and primary care–referable settings (e.g., obstetrics/gynecology clinics, ambulatory care, family planning clinics, correctional facilities, sexually transmitted infection clinics) |
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| Country | Studies conducted in countries categorized as “high” or “very high” on the Human Development Index (as defined by the United Nations Development Programme) |
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| Study design | KQ 1: Randomized, controlled trials; before-after and ecologic studies reporting effect of implementing a widespread screening program with historical or geographic comparator; systematic reviews and meta-analyses (of included study designs)
KQs 2, 3: Randomized, controlled trials; cohort studies; case-control studies; diagnostic accuracy studies; large case series; systematic reviews and meta-analyses (of included study designs) |
Narrative reviews, editorials, and case reports |
| Language | English-language only | Languages other than English |
| Study quality | Fair- or good-quality studies | Poor-quality studies |