Challenges in the Contemporary Management of Syphilis among Pregnant Women in New Orleans, LA.

Irene A Stafford,Charles G Minard,Virginia Fontenot,Martha W Rac,Eliza Rodrigue,Alexandra Berra,Charles M Roitsch,James B Hill,Rachel H Kopkin

doi:10.1155/2019/2613962

Abstract

Objective The aim of this retrospective review is to evaluate trends in the management of maternal and congenital syphilis (CS) in a tertiary care center in New Orleans, LA. Study Design All cases of maternal and neonatal syphilis over a five year period at Touro Infirmary, New Orleans, LA, were identified using ICD-9/10 codes. Charts were reviewed for demographic and obstetrical variables, stage of syphilis at diagnosis, lab values, and treatment regimen. Newborn treatment and other outcomes were recorded. Results During the study period 106 infected mother-baby pairs were identified. Of these, 73 charts are available for review. 41% (n = 30) of women received inadequate therapy according to their stage of disease. 9% of newborns (n = 6) were found to be symptomatic for CS; however, only 83.3% of these were admitted to the neonatal intensive care unit. Only 20% (n = 6) of infants were adequately treated with an extended penicillin regimen if the mother was not adequately treated. Furthermore, only 63.0% of newborns had a nontreponemal titer performed. Conclusion With rising rates of CS, strict adherence to the 2015 CDC guidelines for treatment of syphilis must be maintained.

Highlights

Syphilis is a genital ulcerative disease caused by the bacterium Treponema pallidum that progresses to systemic disease over time when left untreated
The group most affected was men who engage in sexual activities with men, but in recent years, there has been an increase in cases attributed to a growing number of infected women in all regions of the United States and among all ethnic and age groups [6]
3 women in the cohort were diagnosed during the intrapartum period and had no care or complete treatment prior to delivery

Summary

Introduction

Syphilis is a genital ulcerative disease caused by the bacterium Treponema pallidum that progresses to systemic disease over time when left untreated. In the United States, during 2013–2017, the primary and secondary syphilis rate among women more than doubled (increased 155.6%). The rate of infections in pregnant women and their newborns has peaked with over 918 congenital cases reported in the United States during 2017, representing a 153.3% increase relative to 2013 (Center for Disease Control and Prevention [CDC] Sexually transmitted disease surveillance, 2017). There is a 50% risk of fetal infection with maternal primary syphilis increasing to 83% with early latent disease [10, 11]. True risk factors for treatment failure for both the pregnant woman and her fetus are multifactorial and include delayed diagnosis, delayed or inadequate treatment (

Methods

Results

Conclusion