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. 2022 Feb 5;22(1):129.
doi: 10.1186/s12879-022-07100-3.

Gaps in the congenital syphilis prevention cascade: qualitative findings from Kern County, California

Eunhee Park  1 , Julie Yip  2 , Emily Harville  3 , Marlene Nelson  4 , Gloria Giarratano  5 , Pierre Buekens  3 , Jennifer Wagman  6
Affiliations

Gaps in the congenital syphilis prevention cascade: qualitative findings from Kern County, California

Eunhee Park et al. BMC Infect Dis. .

Abstract

Background: Congenital syphilis is preventable through timely access to prenatal care, syphilis screening and treatment of pregnant women diagnosed as infected. In 2018, California had the second highest number of congenital syphilis cases in the United States (U.S.), a nearly twofold increase in cases since 2014. This study assessed gaps in preventing congenital syphilis in the high morbidity region of Kern County, California.

Methods: Between May 2018 and January 2019, we conducted five focus group discussions with pregnant/postpartum women and ten semi-structured interviews with prenatal care providers in Kern County. Focus group and interview data were recorded, transcribed, and analyzed to identify emergent themes pertaining to facilitators and barriers at each step (prenatal care, syphilis screening and treatment) in the congenital syphilis prevention cascade.

Results: Gaps in congenital syphilis prevention discussed in focus group discussions with pregnant/postpartum women were related to limited prenatal care access, social-, economic-, and cultural-barriers, and substance use and co-occurring intimate partner/domestic violence. The gaps identified from interviews with prenatal care providers included social economic vulnerabilities of pregnant women and stigma and shame around the vulnerabilities, distrust in medical system, prenatal substance use, limited prenatal substance use disorder treatment facilities, and inadequate provider training on context-specific congenital syphilis management strategies. Gaps in partner notification, screening and treatment for syphilis were brought up by pregnant/postpartum women and prenatal care providers.

Conclusions: Congenital syphilis continues to increase in Kern County and throughout the U.S. In high syphilis morbidity areas, comprehensive and tailored public health approaches addressing setting-specific gaps in prenatal screening and treatment are needed.

Keywords: Congenital syphilis; Prenatal care; Qualitative methods; Sexually transmitted infection; Social determinants of health; Syphilis screening.

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Conflict of interest statement

All authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper.

Figures

Fig. 1
Fig. 1
Congenital syphilis prevention cascade to identify entry, linkage, and retention gaps in high-risk pregnancy
See this image and copyright information in PMC

References

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