Missed Opportunities for Preventing Congenital Syphilis Infection in New York City

Patel, Sameer J. MD, MPH; Klinger, Ellen J. MPH; O'Toole, Dana BS; Schillinger, Julia A. MD, MSc

doi: 10.1097/AOG.0b013e31826ac25f
Original Research

OBJECTIVE: To describe health care providers' missed opportunities for preventing and treating congenital syphilis in New York City.

METHODS: Review of congenital syphilis cases reported to the New York City Department of Health and Mental Hygiene from January 1, 2000 to December 31, 2009. Receipt and timing of prenatal care, serologic testing, and treatment of mothers and newborns were reviewed. Missed opportunities were defined as receipt of prenatal care plus one of the following: 1) lack of documented treatment for syphilis infection diagnosed before pregnancy; 2) absence of serologic testing during pregnancy; 3) late maternal treatment; 4) maternal treatment with a nonpenicillin regimen; or 5) lack of maternal treatment.

RESULTS: In total, 195 newborns with congenital syphilis were born to 190 mothers with 191 pregnancies. Overall, 80% (95% confidence interval [CI] 74–86%, 152 of 190) of all mothers received prenatal care; 63% (95% CI 56–71%, 96 of 152) of these had one or more missed opportunities for prevention. Twelve mothers received inadequate treatment or no treatment during the case pregnancy for documented syphilis infection before pregnancy, and 42 mothers without previous syphilis diagnosis did not have serologic testing during the case pregnancy. Of 103 mothers with syphilis diagnosed before 30 weeks of gestation, 12 received late penicillin therapy, 27 received no therapy, and 3 received inappropriate (nonpenicillin) therapy. Seventeen percent (95% CI 12–22%, 33 of 193) of liveborn newborns received no treatment during their hospitalization.

CONCLUSION: Providers missed well-defined opportunities to prevent congenital syphilis for the majority of cases. Combined efforts to prevent future cases include provider education and better integration of care between obstetricians and pediatricians.

LEVEL OF EVIDENCE: III

Congenital syphilis in New York City frequently results from missed opportunities for prevention by providers, and the treatment of affected newborns is often suboptimal.

From the Department of Pediatrics, Columbia University, and the Bureau of Sexually Transmitted Diseases Control, New York City Department of Health and Mental Hygiene, New York, New York; and the Division of Sexually Transmitted Diseases Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.

The authors thank Susan Resnick, a computer programmer who provided demographic data for the analysis, and Annot Pierrot-Cox, who is the congenital syphilis surveillance coordinator who supervised data collection and completion of case investigations for the patients included in the study, both at the New York City Department of Health and Mental Hygiene.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Corresponding author: Sameer Patel, MD, 622 West 168th Street, PH 4W-475, New York, NY 10032; e-mail: sp2172@columbia.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2012 The American College of Obstetricians and Gynecologists