Congenital Syphilis on the Rise in the United States

Diana Phillips

November 13, 2015

A sharp rise in the incidence of congenital syphilis between 2012 and 2014 parallels a national increase in primary and secondary syphilis among women during the same period, according to the Centers for Disease Control and Prevention (CDC). The new findings point to the need for more robust public health interventions to prevent the spread of the life-threatening infection.

The overall rate of reported congenital syphilis increased to 11.6 cases per 100,000 live births in 2014, up from 8.4 cases per 100,000 in 2012, an analysis of national surveillance data shows. The 38% increase coincides with a 22% increase in primary and secondary syphilis among women during the same period, Virginia Bowen, PhD, from the CDC's Epidemic Intelligence Service, and colleagues report in the November 13 issue of the Morbidity and Mortality Weekly Report.

During 2012 to 2014, all racial/ethnic groups experienced an increase in case counts and rates of infection, although significant racial disparities in rates of congenital syphilis persist. Among whites, blacks, and Hispanics, rates of congenital infection increased 61%, 19%, and 39%, respectively. "In 2014, the rate among blacks remained approximately 10 times the rate among whites and three times the rate among Hispanics," the authors write.

Geographically, increases in infection rates occurred in all regions, but were greatest in the West, where the rate increased from 5.5 to 12.8 cases per 100,000 live births, the authors report.

In the current analysis, 100 (21.8%) of the 458 mothers of infants with congenital syphilis in 2014 received no prenatal care, and 44 (9.6%) did not receive information about prenatal care.

Of the 314 mothers in this cohort with one or more prenatal visit, 21 were never tested for syphilis during pregnancy, and 52 tested negative in early pregnancy but subsequently acquired the infection before delivery.

In addition, of the women with one or more prenatal visits, 135 (43.0%) did not receive treatment for syphilis during the course of their pregnancy, and 94 (30.0%) received inadequate treatment, the authors report. Of the children born with syphilis, 25 were stillborn and eight died within 30 days of delivery.

Each case of congenital syphilis in the United States is a "sentinel event" that reflects multiple missed opportunities for prevention, according to the authors. "There are two major opportunities to prevent [congenital syphilis]: primary prevention of syphilis among women of reproductive age and men who have sex with women, and prevention of mother-to-infant transmission among pregnant women already infected with syphilis," the authors explain.

In addition to addressing barriers to obtaining quality prenatal care, including sexually transmitted infection screening, prevention initiatives should focus on timely reporting of congenital syphilis and primary and secondary syphilis cases among women of reproductive age, more thorough prenatal screening practices, and timely and appropriate treatment of identified cases, the authors stress.

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2015;64;1241-1245. Full text


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