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Gestational and Congenital Syphilis Epidemic in the Colombian Pacific Coast

Cruz, Adriana R. MD*; Castrillón, Maria Alejandra MD*; Minotta, Alba Yadira RN, MSc; Rubiano, Luisa C. MD, MSc*‡; Castaño, Martha C. RN, MSc; Salazar, Juan C. MD, MPH§¶

doi: 10.1097/OLQ.0000000000000020
Original Study

Background Congenital syphilis (CS) is a major global public health problem. Buenaventura, a socioeconomically deprived municipality in the Colombian Pacific Coast, accounts for 6.6% of all CS cases in Colombia. To begin to understand the main reasons for the high rates of the disease in Buenaventura, we conducted a retrospective electronic health record analysis of all infants admitted with CS during the first 7 months of 2011 to the Hospital Departamental de Buenaventura, the city’s main birthing hospital.

Methods The diagnosis of gestational syphilis and CS was based on a predefined Colombian public health service algorithm. Clinical, laboratory, and sociodemographic parameters for all infants studied, including maternal access to prenatal care, syphilis serologic diagnosis, and adequacy of penicillin treatment, were abstracted and analyzed.

Results A total of 89 infants met the case definition for CS. Most mothers (80%) were affiliated with government-regulated or private health care insurance plans. While 64 (70%) of 92 attended at least 1 antenatal care visit and 59 of these 64 (84%) were screened for syphilis, only 5 (8%) of 59 received appropriate antibiotic therapy. Although most infants were asymptomatic at birth, prematurity (15/82) was common. Two infants died in the neonatal period, and 5 pregnancies ended in stillbirth.

Conclusions Our findings confirm that Buenaventura has a very high incidence of CS and demonstrate that existing antenatal care gestational syphilis programs are flawed. Prevention strategies should emphasize enhanced early syphilis screening in pregnancy, preferably through the implementation of point-of-care testing in the community and same-day treatment with at least 1 dose of penicillin.

Congenital syphilis (CS) cases diagnosed in 2011 during a 7-month period at a single hospital in the Colombian Pacific Coast were studied. A total of 89 cases, including 7 perinatal deaths, are described. Poor antenatal care was the principal cause for the high incidence of congenital syphilis in this region of Colombia.

From the *Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia; †Hospital Departamental de Buenaventura, Buenaventura, Colombia; ‡Secretaría de Salud Departamental del Valle, Cali, Colombia; and §Departments of Pediatrics and Immunology, University of Connecticut Health Center, Farmington, CT; ¶Division of Infectious Diseases, Connecticut Children’s Medical Center, Hartford, CT.

The authors are grateful to Maria del Pilar Gamboa, Hospital Departamentalde Buenaventura epidemiology office assistant; to Sandra Angulo, nurse at the Luis A. Blanque Hospital in Buenaventura; and to Lady Ramirez at Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM) for their support in data collection and processing. The authors also thank Mauricio Pérez for providing support with database creation, management, and statistical analysis and Daniel F. Villota for figure design. They are indebted to Dr Nancy Saravia, CIDEIM’s scientific director, and Dr Maria V. Villegas, CIDEIM’s CEO, for their unwavering support. The authors are particularly grateful to Dr Justin D.Radolf for his mentorship and critical review of the manuscript.

This work was supported by Connecticut Children’s Medical Center’s (CCMC) Arrison and Burr Curtis Research Funds (JCS), Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), COLCIENCIAS Young Investigator Project 0040, 2012 (MAC) COLCIENCIAS Strengthening Project (CIDEIM) 427-2012.

The authors declare no conflicts of interest.

Correspondence: Adriana Raquel Cruz, MD, Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM) Cali, Valle, Colombia. E-mail:

Received for publication April 16, 2013, and accepted June 7, 2013.

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