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Why Maternal Syphilis Screening Matters More Than Ever
At ADLM 2026, Dr. Sarah Bissonnette, Laboratory Director at Marshfield Clinic-Sanford Health in Marshfield, Wisconsin, shared practical insights into how clinical laboratories can strengthen maternal syphilis screening programs through modern diagnostic workflows and optimal screening strategies. Her presentation, Integrated Diagnostic Pathways for Maternal Screening to Reduce Incidence of Congenital Syphilis, highlighted a growing public health challenge that is increasingly relevant across Wisconsin, Michigan, the broader United States, and around the world.
Dr. Bissonnette’s message was clear: syphilis is no longer a rare infection encountered occasionally. Rising rates of both adult and congenital syphilis1 require healthcare systems to rethink screening approaches, improve testing access, and adopt technologies that help identify infections earlier and more reliably.
A Growing Public Health Concern in Wisconsin and Beyond
Dr. Bissonnette noted that congenital syphilis cases in Wisconsin increased by 24% from 2023 to 2024, despite the decrease in overall syphilis cases as well as other sexually transmitted infections (STIs) during that time.2 While syphilis is treatable, congenital syphilis can cause miscarriage, stillbirth, premature birth, low birth weight, and death.3 Therefore, the Wisconsin Department of Health Services and many other places, recommend syphilis testing during pregnancy at multiple time points, including the first trimester, around 28 weeks gestation, and at delivery.2
These local trends mirror broader national concerns. CDC surveillance data shows increases in both adult and congenital syphilis infections, reinforcing the need for proactive screening programs and timely laboratory testing.4 The growing number of cases has prompted several states in the U.S. to update prenatal testing requirements and screening policies.5–7
Rural communities, geographically dispersed patient populations, and variable access to specialty care can create barriers to screening and follow-up. In these settings, laboratory testing becomes an especially important gateway to diagnosis, treatment, and prevention of transmission. Syphilis has re-emerged as a global public health concern, with the World Health Organization reporting millions of new infections each year worldwide.8 In many regions, health systems are grappling with rising rates among reproductive-age adults and a corresponding increase in congenital syphilis cases.9 Limited access to healthcare, delayed prenatal care, and gaps in routine screening continue to contribute to preventable maternal and neonatal infections.10
Whether in rural Wisconsin or underserved communities around the world, early identification remains one of the most effective tools for reducing disease transmission and improving outcomes.10,11
The role of the clinical laboratory
As cases rise globally, laboratories play a critical role in delivering accurate testing to detect infections, guide timely treatment, and support public health efforts, highlighting the importance of modern diagnostics and coordinated screening programs.
Dr. Bissonnette also highlighted the importance of looking beyond traditional prenatal settings. Emergency departments represent an often-underused opportunity for screening, particularly for patients who may not consistently engage with routine prenatal care. Stronger coordination between emergency medicine, obstetrics, public health programs, and laboratory services can help close screening gaps and identify infections that might otherwise go undetected.
The Value of High-Sensitivity Testing
One of the central themes of Dr. Bissonnette’s presentation was the role of updated treponemal laboratory tests in modern infectious disease screening programs. Laboratories may need Automated testing solutions may aid laboratories in addressing the increase in syphilis testing demands. Ensuring tests and testing algorithms must combine both accurate detection with efficient workflows and rapid turnaround times to ensure screening program success.
CDC recommendations recognize the value of automated treponemal immunoassays for supporting both traditional and reverse screening algorithms in high-volume testing environments.12 The Beckman Coulter Access Syphilis assay, available on the DxI 9000 and Access 2 immunoassay analyzers, is an automated treponemal immunoassay solution that may enable laboratories to streamline workflows and realize the benefits of using the reverse algorithm. When a treponemal test, such as Access Syphilis, is used in conjunction with a non-treponemal test, such as RPR, using the reverse algorithm workflow, laboratories may see both operational and clinical benefits, such as reduced TAT and improved detection of early-stage infections.11,12
Dr. Bissonnette emphasized that testing accuracy alone is not enough. In an environment where laboratories must ensure that results are reported quickly, interpreted appropriately, and connected to timely clinical action, testing accuracy must function within an optimized workflow from preanalytical specimen collection through treatment initiation to enable timely testing, reporting, interpretation, and treatment.
Looking Ahead
The resurgence of syphilis serves as a reminder that infectious disease threats do not disappear simply because they become less visible—and that diseases reemerge and cause significant harm when left unchecked. As incidence rises across many regions of the U.S., laboratories are being called upon to provide faster, more reliable screening and stronger support for public health initiatives.13
Dr. Bissonnette's ADLM 2026 presentation underscored how integrated diagnostic pathways using updated treponemal tests alongside non-treponemal tests, and collaboration across care settings can help address this challenge. By strengthening screening programs and reducing missed opportunities for diagnosis, laboratories can support earlier detection and help facilitate timely patient management.
Watch the recording of Dr. Bissonnette's ADLM 2026 presentation below. She offers a valuable perspective for laboratory professionals, clinicians, and public health stakeholders working to modernize STI screening and improve maternal and overall health outcomes.
