Factors Contributing to Congenital Syphilis Cases - New York City, 2010-2016

Abstract

Congenital syphilis occurs when syphilis is transmitted from a pregnant woman to her fetus; congenital syphilis can be prevented through screening and treatment during pregnancy. Transmission to the fetus can occur at any stage of maternal infection, but is more likely during primary and secondary syphilis, with rates of transmission up to 100% at these stages (1). Untreated syphilis during pregnancy can cause spontaneous abortion, stillbirth, and early infant death. During 2013-2017, national rates of congenital syphilis increased from 9.2 to 23.3 cases per 100,000 live births (2), coinciding with increasing rates of primary and secondary syphilis among women of reproductive age (3). In New York City (NYC), cases of primary and secondary syphilis among women aged 15-44 years increased 147% during 2015-2016. To evaluate measures to prevent congenital syphilis, the NYC Department of Health and Mental Hygiene (DOHMH) reviewed data for congenital syphilis cases reported during 2010-2016 and identified patient-, provider-, and systems-level factors that contributed to these cases. During this period, 578 syphilis cases among pregnant women aged 15-44 years were reported to DOHMH; a congenital syphilis case was averted or otherwise failed to occur in 510 (88.2%) of these pregnancies, and in 68, a case of congenital syphilis occurred (eight cases per 100,000 live births).* Among the 68 pregnant women associated with these congenital syphilis cases, 21 (30.9%) did not receive timely (≥45 days before delivery) prenatal care. Among the 47 pregnant women who did access timely prenatal care, four (8.5%) did not receive an initial syphilis test until <45 days before delivery, and 22 (46.8%) acquired syphilis after an initial nonreactive syphilis test. These findings support recommendations that health care providers screen all pregnant women for syphilis at the first prenatal care visit and then rescreen women at risk in the early third trimester.

FIGURE

Clinical care and public health management of pregnancies among women who delivered an infant with congenital syphilis — New York City, 2010–2016^,†,§ * Box a includes pregnant women with no documentation of prenatal care or syphilis screening ≥45 days before delivery. Box b includes pregnant women with prenatal care documented ≥45 days before delivery but no documentation of syphilis screening ≥45 days before delivery. Box c includes pregnant women with documentation of a reactive test for syphilis ≥45 days before delivery and documentation of adequate treatment initiated <30 days before delivery or no documentation of adequate treatment initiated before delivery. Box e includes pregnant women with documentation of a nonreactive test for syphilis ≥45 days before delivery, no documentation of syphilis screening between 28 weeks’ gestation (estimated) and ≥45 days before delivery, and documentation of a reactive test <30 days before or at delivery such that infection was believed to have been acquired just before delivery. ^† Box d includes pregnant women who had a documented reactive test for syphilis, initiated adequate treatment ≥30 days before delivery, but nonetheless had changes in serologic tests indicating reinfection late in pregnancy (e.g., increased nontreponemal titers). Box f includes pregnant women with documentation of a nonreactive test for syphilis between 28 weeks’ gestation (estimated) and ≥45 days before delivery and documentation of a reactive test <30 days before or at delivery such that infection was believed to have been acquired just before delivery. ^§ Box d includes two pregnant women who had stable nontreponemal titers during pregnancy (and therefore did not meet maternal criteria for reporting a congenital syphilis case), but who delivered an infant with signs and symptoms that met the infant criteria for a probable congenital syphilis case.