2 ﬁrst-visit testing and delivery. Screening for syphilis utilized nontreponemal tests of serum samples conﬁrmed with tre- ponemal tests. Screening for gonorrhea and Chlamydia tra- chomatis infection used a combined test of DNA probes from cervical swab specimens. The exact types of tests and manu- facturers varied, depending on the payer-speciﬁed laboratory for speciﬁc patients. The University of Florida Health Science Center Institutional Review Board approved the study. Subjects meeting criteria for inclusion in the cohort were identiﬁed from the delivery log maintained in the Labor and Delivery Unit at Shands Hospital at the University of Florida and from the database maintained by the Division of Maternal-Fetal Medicine at the University of Florida. Medi- cal record charts of these women were abstracted, and data were entered into a relational database (Access 2000, Mi- crosoft Corporation, Redmond, Wash). SAS Version 9.0 (SAS Institute, Cary, NC) was utilized for statistical analysis. Rates of screening for syphilis at the ﬁrst prenatal visit and again in the third trimester were calculated. The preva- lence of infection with 95% conﬁdence intervals (CIs) (mod- iﬁed Wald method) was calculated. We anticipated that the inclusion of one year of delivered patients would yield a cohort of over 1000 patients undergoing repeated third- trimester screening, allowing 95% conﬁdence intervals of less than 3%. The unpaired Student’s t test was used for contin- uous data. Categorical data were analyzed with the uncor- rected chi-square and Fisher’s exact tests as appropriate. All tests of statistical signiﬁcance were two-tailed and utilized an alpha of 0.05. RESULTS During the study interval, 2244 women delivered at our hos- pital, and 2085 charts were available for review. Of the 1962 women who had at least one prenatal care visit, the mean age was 25.8 (standard deviation (SD) = 6.3) years. Fifty seven percent of women were white, 25% were black, and 18% were of other ethnicities. Sixty two percent of women were parous, 64% were unmarried, 75% had either government- sponsored or “self-”payer status, and 18% reported a prior history of at least one sexually transmitted infection (gon- orrhea, Chlamydia, syphilis, genital herpes, trichomoniasis, or HIV). The ﬁrst prenatal visit for these patients occurred at a mean gestational age of 13.7 (SD = 6.9) weeks. Of the 1962 women who had at least one prenatal care visit, 1724 (87.9%) were screened for gonorrhea and Chlamydia trachomatis infection at the ﬁrst prenatal care visit. Of these women, 19 (1.1%) had gonorrhea and 107 (6.2%) had a Chlamydia trachomatis infection. Of the 1962 women who had at least one prenatal care visit, 1940 (98.9%) were screened for syphilis at the ﬁrst pre- natal care visit. No cases of syphilis were identiﬁed with this initial screening (95% conﬁdence interval (CI) = 0, 0.24%). Of the 1627 women beginning prenatal care prior to 27 weeks and delivering after 32 weeks, 1377 (84.6%) were screened in the third trimester. Similar to the results of screening at the ﬁrst prenatal visit, no cases of syphilis were identiﬁed with third trimester screening (95% CI = 0, 0.34%). Infectious Diseases in Obstetrics and Gynecology DISCUSSION Our study is limited by its retrospective nature. Also, these data are from a single center during a single year, and they may not be generalizable to other obstetric populations. However, the prevalence rates of gonorrhea and Chlamydia trachomatis infection in our population are similar to those in other high-risk clinic populations [10]. Therefore, we be- lieve that it is unlikely that the prevalence of syphilis in our population is signiﬁcantly lower than it would be in the ma- jority of practice settings in the United States. In this study, compliance with our state’s legal require- ment for screening for syphilis at the ﬁrst visit was excel- lent (98.9%). Others have reported similarly high ﬁrst-visit screening rates for syphilis and for other tests that are in- cluded in some sort of “prenatal battery” [11]. Compliance with the legal requirement for repeating screening in the third trimester was lower (84.6%). Reasons for this lower rate of screening than at the ﬁrst visit likely include patient refusal and provider apathy due to the rarity of the infection. The primary goal of screening pregnant women for syphilis is to prevent cases of congenital syphilis. Currently, the total number of cases in the United States each year is ap- proximately 400 [9]. As with the rate of syphilis in women, the incidence of syphilis in newborns also is decreasing. Syphilis disproportionately aﬀects those living in urban ar- eas. Most counties in our state and others rarely report a case of primary or secondary syphilis in adults, much less a case of congenital syphilis. Clearly, because of the untoward consequences of con- genital syphilis, screening women once during pregnancy for this infection is reasonable and well justiﬁed. However, we believe that the statutory requirement, as currently exists in Florida and 8 other states, to screen all women twice during pregnancy for an infection that is as rare as syphilis currently should be reevaluated. ACKNOWLEDGMENT This research is supported by departmental funds. REFERENCES [1] Centers for Disease Control and Prevention. Sexually trans- mitted diseases treatment guidelines 2002. Morbidity and Mor- tality Weekly Report. 2002;51(RR-6):1–80. [2] Hollier LM, Hill J, Sheﬃeld JS, Wendel GD Jr. State laws re- garding prenatal syphilis screening in the United States. Amer- ican Journal of Obstetrics and Gynecology. 2003;189(4):1178– 1183. [3] Stray-Pedersen B. Is screening for genital infections in preg- nancy necessary? Acta Obstetricia et Gynecologica Scandinav- ica. 1997;76(suppl 164):116–120. [4] Ries AM. Neisseria gonorrhoeae screening in pregnancy. Mili- tary Medicine. 2000;165(7):549–551. [5] Stoll BJ, Kanto WP Jr, Glass RI, Pushkin J. Treated maternal gonorrhea without adverse eﬀect on outcome of pregnancy. Southern Medical Journal. 1982;75(10):1236–1238.