Situation: A 26-year-old woman comes to the Rural Health Unit (RHU) for her first prenatal visit on May 6, 2026. Her last menstrual period (LMP) began on January 28, 2026, and her menstrual cycles have always been regular at 28 days. She has no medical conditions and reports no danger signs. At this first visit, the nurse arranges the infection screening that the Department of Health (DOH) includes in prenatal care for every pregnant woman to prevent mother-to-child transmission. Which three infections are screened?

The DOH prenatal package screens every pregnant woman for syphilis, human immunodeficiency virus (HIV), and hepatitis B, three infections that can pass to the baby and can be prevented or treated. Hepatitis C screening and rubella immunity testing appear in U.S. first-visit panels, and group B streptococcus is cultured late in pregnancy, at 36 to 37 weeks, not at the first visit.

Core concept: DOH first-visit prenatal infection screening

The Department of Health prenatal care package requires that every pregnant woman be screened at the initial visit for three infections that can be transmitted from mother to child and that have effective interventions: syphilis, human immunodeficiency virus (HIV), and hepatitis B. These three are grouped together because vertical transmission of each can be meaningfully reduced when the infection is identified early in pregnancy and the appropriate treatment or prophylaxis is started.

The unifying principle is that screening is only useful when an effective intervention exists and when the timing of that intervention matters. Syphilis can be treated with penicillin during pregnancy to prevent congenital syphilis. HIV can be managed with antiretroviral therapy and delivery planning to reduce perinatal transmission. Hepatitis B can be addressed by identifying HBsAg-positive mothers and giving the newborn hepatitis B immune globulin plus vaccine within hours of birth. All three interventions require knowing the mother’s status before delivery, which is why these tests belong at the first prenatal visit rather than later.

The World Health Organization has explicitly prioritized elimination of vertical transmission of these same three diseases—syphilis, HIV, and hepatitis B—as a combined global target ^[2]. This grouping is not arbitrary; it reflects the shared public health logic that these infections are major contributors to maternal and neonatal morbidity and mortality, especially in resource-limited settings, and that antenatal screening programs can reduce that burden ^[2]. A systematic review of interventions to improve antenatal screening in low- and middle-income countries likewise treats syphilis, HIV, and hepatitis B as the core screening triad ^[2].

The Dutch antenatal screening program provides a concrete example of how these three tests function together in practice. Since 2004, universal HIV screening using an opt-out approach was added to the existing hepatitis B and syphilis screening that had been in place since the 1950s, and the program was evaluated specifically for its effectiveness in preventing mother-to-child transmission of all three infections ^[1]. This reinforces the concept that the screening panel is built around infections for which vertical transmission can be interrupted.

Infection	Why screen at first visit	Key intervention after positive result
Syphilis	Treatable during pregnancy; early treatment prevents congenital syphilis	Penicillin therapy for the mother
HIV	Antiretroviral therapy and delivery planning reduce perinatal transmission	Maternal ART; intrapartum and neonatal prophylaxis
Hepatitis B	Newborn immunoprophylaxis must be given within hours of birth	HBIG plus hepatitis B vaccine for the neonate

Watch out! Hepatitis C is not part of the DOH first-visit screening triad. While hepatitis C can be transmitted vertically, it appears in some international first-visit panels but is not included in the Philippine DOH prenatal package described in this scenario. Do not add it simply because it is a blood-borne virus.

Watch out! Rubella immunity testing is also not part of the DOH first-visit screening triad. Rubella is included in TORCH panels used in some settings, and a recent study of first-trimester TORCH seropositivity in pregnant women included rubella virus, cytomegalovirus, hepatitis B, hepatitis C, HIV, syphilis, and Toxoplasma gondii . However, TORCH panels are broader screening tools used for specific clinical or epidemiological purposes, not the standard DOH prenatal infection screen for every pregnant woman.

Key point! Group B streptococcus (GBS) is not screened at the first prenatal visit. GBS culture is performed late in pregnancy, typically at 36 to 37 weeks, because colonization status can change during pregnancy and the result is only relevant for intrapartum antibiotic prophylaxis. A first-visit GBS culture would not guide management at delivery.

The timing distinction is clinically important. First-visit screening targets infections for which early knowledge changes management across the entire pregnancy, while late-pregnancy screening targets organisms whose status at delivery is what matters. Syphilis, HIV, and hepatitis B require early identification because treatment or prophylaxis must begin well before labor or immediately at birth. GBS requires late identification because only colonization near term predicts neonatal exposure risk.

A cross-sectional study of pregnant women attending antenatal care in Luanda, Angola, screened for HIV and then tested HIV-reactive women for hepatitis B, hepatitis C, and syphilis co-infection, illustrating that these infections are commonly assessed together in antenatal settings where vertical transmission is a concern . The study’s focus on co-infection among HIV-positive pregnant women underscores the clinical relevance of identifying multiple infections simultaneously, since co-infected mothers may require coordinated management .

In summary, the correct answer is option 4 because the DOH prenatal package screens every pregnant woman for HIV, syphilis, and hepatitis B at the first visit. Hepatitis C and rubella are not part of this core DOH triad, and group B streptococcus is cultured late in pregnancy, not at the initial prenatal encounter.