In some models, repeat screening improved infant outcomes and was cost-effective.

First-trimester screening for syphilis is routine, as the consequences of untreated disease are dire (e.g., high risk for stillbirth, neonatal impairment) and penicillin therapy is effective and inexpensive. However, women may acquire — or reacquire — syphilis later in pregnancy. Investigators developed a model using a theoretical cohort of 3.9 million women to see whether third-trimester rescreening can improve outcomes and save money.

Based on published estimates of costs and outcomes and a cost-effectiveness threshold of $100,000 per quality-adjusted life-year, the model indicates that third-trimester repeat syphilis screening is cost-effective: The practice would result in 41 fewer neonates with congenital syphilis, 73 fewer stillbirths, 27 fewer infant deaths, and a cost saving of $52 million.