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Increasing Syphilis Diagnoses Among Females Giving Birth in US Hospitals, 2010–2014

Aslam, Maria V. PhD; Owusu-Edusei, Kwame PhD, MS; Kidd, Sarah E. MD; Torrone, Elizabeth A. PhD; Dietz, Patricia M. DrPH, MPH

Sexually Transmitted Diseases: March 2019 - Volume 46 - Issue 3 - p 147–152
doi: 10.1097/OLQ.0000000000000945
Original Studies

Background National trends in syphilis rates among females delivering newborns are not well characterized. We assessed 2010–2014 trends in syphilis diagnoses documented on discharge records and associated factors among females who have given birth in US hospitals.

Methods We calculated quarterly trends in syphilis rates (per 100,000 deliveries) by using International Classification of Diseases, Ninth Revision, Clinical Modification codes on delivery discharge records from the National Inpatient Sample. Changes in trends were determined by using Joinpoint software. We estimated relative risks (RR) to assess the association of syphilis diagnoses with race/ethnicity, age, insurance status, household income, and census region.

Results Overall, estimated syphilis rates decreased during 2010–2012 at 1.0% per quarter (P < 0.001) and increased afterward at 1.8% (P < 0.001). The syphilis rate increase was statistically significant across all sociodemographic groups and all US regions, with substantial increases identified among whites (35.2% per quarter; P < 0.001) and Medicaid recipients (15.1%; P < 0.001). In 2014, the risk of syphilis diagnosis was greater among blacks (RR, 13.02; 95% confidence interval [CI], 9.46–17.92) or Hispanics (RR, 4.53; 95% CI, 3.19–6.42), compared with whites; Medicaid recipients (RR, 4.63; 95% CI, 3.38–6.33) or uninsured persons (RR, 2.84; 95% CI, 1.74–4.63), compared with privately insured patients; females with the lowest household income (RR, 5.32; 95% CI, 3.55–7.97), compared with the highest income; and females in the South (RR, 2.42; 95% CI, 1.66–3.53), compared with the West.

Conclusions Increasing syphilis rates among pregnant females of all backgrounds reinforce the importance of prenatal screening and treatment.

Using a nationally representative sample of hospitalizations, we document increased syphilis rates among all sociodemographic groups of US females delivering newborns, with substantial increases identified among whites and Medicaid recipients.

From the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA

Conflict of Interest and Sources of Funding: None declared.

Correspondence: Maria Vyshnya Aslam, PhD, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. MS E-07, Atlanta, GA 30329-4027. E-mail:

Received for publication July 27, 2018, and accepted November 4, 2018.

© Copyright 2019 American Sexually Transmitted Diseases Association