Preventing Congenital Syphilis: A Rapid Screening Approach

Introduction This quality improvement (QI) project aimed to reduce congenital syphilis rates by developing a rapid screening protocol to improve early detection and treatment during pregnancy. Congenital syphilis is an increasing public health concern in Texas and across the United States, despite existing CDC screening guidelines. Delays in diagnosis due to inadequate prenatal care and barriers to timely testing contribute to rising rates, particularly among underserved populations. In 2022, Texas reported 922 cases, accounting for 25% of the national total. Of these cases, half of the pregnant women were receiving prenatal care in the third trimester. Methodology Guided by the Triple Aim framework, a rapid syphilis screening protocol was designed using CDC and Texas DSHS guidelines and manufacturer performance data. The proposed intervention includes opt-out rapid screening at multiple prenatal stages. A cost-benefit analysis compared implementation costs with potential savings from avoided cases. Results Manufacturer data indicated that rapid syphilis testing provides high sensitivity (98%) and specificity (97.2%), with results available within 10 minutes. These findings support rapid testing as an effective strategy to improve early diagnosis and treatment rates. The cost-benefit analysis estimated a 5,447% return on investment, with projected annual savings of approximately $26.5 million by preventing up to 461 cases in Texas. Implications for Practice Adding a rapid screening protocol to prenatal care can improve maternal and neonatal outcomes, particularly in high-risk populations. This QI project underscores the role of nurse-led initiatives in closing care gaps and reducing health disparities through timely, cost-effective interventions.