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Characteristics Associated With Delivery of an Infant With Congenital Syphilis and Missed Opportunities for Prevention—California, 2012 to 2014

Biswas, Hope, H., PhD, ScM*†; Chew Ng, Rilene, A., DrPH, MPH; Murray, Erin, L., PhD, MSPH; Chow, Joan, M., DrPH, MPH; Stoltey, Juliet, E., MD, MPH; Watt, James, P., MD, MPH; Bauer, Heidi, M., MD, MPH

Sexually Transmitted Diseases: July 2018 - Volume 45 - Issue 7 - p 435–441
doi: 10.1097/OLQ.0000000000000782
Original Studies

Background Congenital syphilis (CS), the transmission of Treponema pallidum from mother to fetus during pregnancy, can cause adverse birth outcomes. In 2012 to 2014, the CS rate in California increased more than 200% from 6.6 to 20.3 cases per 100,000 live births. Our objectives were to identify characteristics associated with delivering an infant with CS and missed opportunities for prevention among syphilis-infected pregnant women in California.

Methods We linked California Department of Public Health syphilis surveillance records from women aged 15 to 45 years—diagnosed from March 13, 2012, to December 31, 2014—to birth records. We compared characteristics among mothers who delivered an infant with CS (CS mothers) with mothers who delivered an infant without CS (non-CS mothers) by using χ2 or Fisher exact tests. To visualize gaps in prevention among syphilis-infected pregnant women, we constructed a CS prevention cascade, a figure that shows steps to prevent CS.

Results During the selected period, 2498 women were diagnosed as having syphilis, and 427 (17%) linked to birth records; 164 (38%) were defined as CS mothers and 263 (62%) as non-CS mothers. Mothers with CS were more likely than non-CS mothers to have their first prenatal care visit in the third trimester. High proportions of mothers in both groups reported high-risk sexual behaviors, methamphetamine use, or incarceration (13%–29%). The CS prevention cascade showed decrements of 5% to 11% in prenatal care receipt, testing, and treatment steps; only 62% of potential CS births were prevented.

Conclusions Multifaceted efforts are needed to address gaps in the CS prevention cascade and reduce CS cases in California.

We identified missed opportunities for congenital syphilis prevention in prenatal care receipt, syphilis testing, and treatment during pregnancy; only 62% of potential congenital syphilis births were prevented.

From the *Division of Scientific Education and Professional Development, Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; and

California Department of Public Health, Richmond, CA

Acknowledgments: The authors thank Susie Baldwin, Ryan Murphy, Shantel Muldrow, Monica Muñoz, and Aineeh Montano at the Los Angeles County Department of Public Health for their assistance with this project, as well as Raquel Paz and Lupe Espain at the California Department of Public Health for their assistance with record review and Denise Gilson at the California Department of Public Health for her database expertise. Finally, the authors thank Sarah Kidd at the Centers for Disease Control and Prevention for her advice and insights on congenital syphilis.

Conflict of Interest and Sources of Funding: None declared.

Disclaimer: 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.

Correspondence: Hope H. Biswas, PhD, ScM, California Department of Public Health, Division of Communicable Disease Control, 850 Marina Bay Parkway, Building P, 2nd Floor, Richmond, CA 94804. E-mail:

Received for publication September 29, 2017, and accepted December 22, 2017.

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© Copyright 2018 American Sexually Transmitted Diseases Association