AT THE 2016 STD PREVENTION CONFERENCE
ATLANTA (FRONTLINE MEDICAL NEWS) – Physicians are falling short on syphilis testing in both the prenatal period and at the time of delivery, suggest the findings of a study examining insurance claims from nearly 10,000 women who experienced stillbirths.
Overall, less than 10% of women in the study were tested for syphilis following a stillbirth delivery, while less than two-thirds of women who experienced a stillbirth had received prenatal syphilis testing.
“Both [the Centers for Disease Control and Prevention] and [the American College of Obstetricians and Gynecologists] recommend that all pregnant women should be tested for syphilis at first prenatal visit,” Chirag G. Patel , DC, MPH, a CDC researcher, said at a conference on STD prevention sponsored by the agency. “According to CDC, if any woman delivers a stillbirth at 20 weeks of gestation or more, she should be tested for syphilis.”
Dr. Patel and his coinvestigators examined data from the Truven Health MarketScan Medicaid and commercial claims database to evaluate the proportion of women who had syphilis testing within at least 1 week before and 1 week after a stillbirth delivery.
The investigators identified women aged 15-44 years who had a stillbirth delivery in 2013. Stillbirths were identified via ICD-9 codes and these codes were also used to track prenatal syphilis testing, as well as syphilis testing, placental examination and complete blood count (CBC) performed at the time of delivery.
In total, there were 3,731 women enrolled in Medicaid and 6,096 commercially-insured women who experienced stillbirths and were included in the study. Of these women, 65.5% of Medicaid-covered women and 56.6% of commercially-insured women received prenatal syphilis testing. At delivery, 6.5% of Medicaid-insured women and 9.3% of commercially-insured women received syphilis testing.
Most women in the study were receiving prenatal care. In all, 73.2% of Medicaid-covered women and 76.5% of commercially-insured women received it. Placental examination at the time of delivery occurred for 61.5% of Medicaid-covered women and 58.0% of commercially-insured women, while CBC was performed in 31.2% and 35.8% of women, respectively.
“Overall, prenatal syphilis testing was significantly higher than syphilis testing at the time of delivery,” Dr. Patel said. “Women with prenatal syphilis testing were more likely to be tested for syphilis at delivery than those not tested, regardless of [their] insurance.”
Dr. Patel did not report information on financial disclosures.