Maternal and congenital syphilis in Brooklyn, NY. Epidemiology, transmission, and diagnosis

Abstract

Objective: To define the epidemiology, to determine factors associated with transmission, and to describe the clinical and laboratory features of congenital syphilis.

Design: Retrospective chart review and prospective analysis.

Setting: Kings County Hospital Center, Brooklyn, NY.

Patients: A total of 403 pregnancies during a 23-month period associated with positive syphilis serological findings.

Results: Seventy-three pregnancies (18%) resulted in congenital syphilis (35 live-born and 40 stillborn neonates). Pregnancies associated with congenital syphilis were significantly associated with lack of prenatal care, lack of maternal therapy for syphilis, and a higher rapid plasma reagin titer, but not with a reported history of "crack" or cocaine use, although detection of cocaine in urine samples was more likely with positive syphilis serology.

Conclusion: Most live-born infants with congenital syphilis (23 of 35) lacked rash, hepatosplenomegaly, or adenopathy but were identified by laboratory tests (roentgenograms, cerebrospinal fluid VDRL test, conjugated bilirubin determination, or aspartate aminotransferase levels in serum samples). Half of the infants with congenital syphilis were stillborn.