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Challenges in Congenital Syphilis Surveillance: How Are Congenital Syphilis Investigations Classified?

Introcaso, Camille E. MD*; Gruber, DeAnn PhD; Bradley, Heather PhD*; Peterman, Thomas A. MD, MS*; Ewell, Joy BS; Wendell, Debbie PhD, MPH; Foxhood, Joseph BS; Su, John R. MD, PhD, MPH*; Weinstock, Hillard S. MD, MPH*; Markowitz, Lauri E. MD*

doi: 10.1097/01.olq.0000431352.50346.fb
Original Study

Background Congenital syphilis is a serious, preventable, and nationally notifiable disease. Despite the existence of a surveillance case definition, congenital syphilis is sometimes classified differently using an algorithm on the Centers for Disease Control and Prevention’s case reporting form.

Methods We reviewed Louisiana’s congenital syphilis electronic reporting system for investigations of infants born from January 2010 to October 2011, abstracted data required for classification, and applied the surveillance definition and the algorithm. We calculated the sensitivities and specificities of the algorithm and Louisiana’s classification using the surveillance definition as the surveillance gold standard.

Results Among 349 congenital syphilis investigations, the surveillance definition identified 62 cases. The algorithm had a sensitivity of 91.9% and a specificity of 64.1%. Louisiana’s classification had a sensitivity of 50% and a specificity of 91.3% compared with the surveillance definition.

Conclusions The differences between the algorithm and the surveillance definition led to misclassification of congenital syphilis cases. The algorithm should match the surveillance definition. Other state and local health departments should assure that their reported cases meet the surveillance definition.

A review of congenital syphilis investigations in Louisiana found that the algorithm on the federal case reporting form classifies many more investigations as cases compared with the surveillance definition.

From the *Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, and †Louisiana Office of Public Health STD/HIV Program, New Orleans, LA

Sources of support: None.

The authors have no conflicts of interest to disclose.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention. Mention of company names or products does not imply endorsement by the Centers for Disease Control and Prevention.

Correspondence: Camille E. Introcaso, MD, Centers for Disease Control and Prevention, Corporate Square Building 10, MS E-02, Atlanta, GA 30329. E-mail:

Received for publication February 26, 2013, and accepted May 6, 2013.

© Copyright 2013 American Sexually Transmitted Diseases Association